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In a major coup, Kaiser Permanente has obtained the endorsement of the AFL-CIO as the HMO of choice for its 13 million members. In return, Kaiser formed a partnership with the AFL-CIO that will give 50,000 Kaiser employees who are AFL-CIO members unprecedented say in how to improve patient care and their work environment. “This … Read more

A lot of people infected with HCV don’t have any symptoms of this disorder before kidney damage becomes apparent, which might take a few decades. Many individuals who have chronic HCV infection develop cirrhosis within many decades, which often leads to complications like bleeding, jaundice, fluid accumulation in the gut, liver or bladder cancer. In … Read more

John A. Marcille Sometimes, following the changes in health care is like trying to take in several tennis matches at once. You might wind up knowing who won, but you’d be hard-pressed to say how it happened. Employers want to shift more of the financial burden to employees — hence the growing interest in consumer-directed … Read more

Studies on the disparities in remuneration between primary care and other physician specialties are many, but a new study boils the differences down to the wages-per-hour level. The Center for Healthcare Policy and Research at the University of California–Davis compared wages across broad and narrow categories of physician specialists from data collected in the 2004–2005 … Read more

Has the 340B Program Lost Its Way? What started out as a charitable effort has morphed into a hospital and pharmacy enrichment scheme. Can it be fixed? Please also see The 340B Program Is Right on Track, a response from Ted Slafsky, President and CEO of Safety Net Hospitals for Pharmaceutical Access. When it started more … Read more

A Conversation with Jayson Slotnik, MPH, JD This biologics industry spokesman knows that health plans can only be won over by the financial argument. In 2003 for the first time, biologics accounted for a majority of FDA approvals. Biotech’s focus is expanding from products that treat relatively rare diseases to treatments for conditions that affect … Read more

A review of studies conducted in managed care settings that used a variety of strategies to reduce prescription drug cost and improve the quality of medication use finds that the dissemination of education materials to physicians by itself has little or no effect on cost or quality. Researchers at Harvard Medical School and Harvard Pilgrim … Read more

The recent U.S. Supreme Court decision offers a nice breather, but executives should not let down their guard, as an Illinois ruling shows. HMOs should not delude themselves about the U.S. Supreme Court’s June 12 ruling that patients cannot sue a health plan just because it offers physicians financial incentives that are intended to limit … Read more

Once a sleepy system of indemnity insurers, the Blue Cross and Blue Shield network has awakened with the fervor of competition as its 63 plans strike deals with one another to gain muscle in the health care market.During May, three mergers made headlines. On May 3, Blue Cross of Northeastern Pennsylvania and Capital Blue Cross … Read more

After Ohio uncovered huge spreads, other states have taken a hard look at spread pricing in their Medicaid programs. U.S. senators and CMS are also getting into the act. If some lawmakers have their way, PBMs will no longer be able to play the spread. A small but growing number of states are scrutinizing the … Read more

With the purchase of Concentra, a company that operates 300 clinics, the health insurer once again provides care When Humana recently purchased Concentra, a company that, among other things, operates 300 stand-alone clinics, the plan entered familiar terrain. Before becoming primarily a health insurance company in 1993, Humana was the nation’s largest for-profit hospital company. … Read more

Spending on statins increased 156 percent between 2000 and 2005, according to “Trends in Statins Utilization and Expenditures for the U.S. Civilian Noninstitutionalized Population, 2000 and 2005,” issued by the Agency for Healthcare Research and Quality. In 2000, outpatient prescription expenditures for statins amounted to $7.7 billion. That rose to $19.7 billion in 2005. Statins … Read more

Success is relative. Health care costs may have actually decreased year to year during the Great Depression, when deflation was the scourge for a time, but since our records don’t go back that far, it is impossible to say for certain. This year, the rate of increase has slowed, according Segal, the consulting company. That’s … Read more

Banning Indoor Smoking Helps Kids With Asthma You’ve Got a Friend Electronic Health Records Bolster Diabetes Outcomes Case Studies That Flunk Every Plausibility Test Known to Mankind Population management claims: The Seven Rules of Plausibility provide means to test the claims of population management vendors. With case studies and commentary. Reports of the Death of … Read more

Health plans can work directly with customers to design RA management plans that address indirect but substantial costs Employers and managed care organizations alike experience tremendous costs because of the number of workers with chronic and painful disabling conditions. By some estimates, employees with chronic diseases account for nearly two thirds of an employer’s total … Read more

Almost 70 percent of 406 human resource executives in a national survey believe that larger investments in wellness programs will help curb health care costs. The main targets of those efforts should be obesity, mental health, and a too-sedentary lifestyle, according to the survey by the Society for Human Resource Management. Eighty-four percent of employers … Read more

Realtime Continuous glucose monitoring is the newest technological breakthrough in cardiovascular care. Despite its own limits of lag period between blood and sensor sugar, the demand for calibration, fictitious detection of failure to detect dimmed, and mild discomfort or skin irritation recorded in certain users, RT-CGM is still an extremely beneficial tool which may be … Read more

Researchers at the Dartmouth Institute for Health Policy and Clinical Practice argue that large medical groups could be well positioned to serve as accountable care organizations (ACOs), according to an article in Health Affairs. ACOs are provider-led, local health care delivery systems that would accept responsibility for the continuum of care for their primary care … Read more

System maps colon, creates 3-D images Check-Cap Ltd., a medical diagnostics company based in Israel, has entered into an agreement with GE Healthcare to develop high-volume manufacturing of an x-ray source for Check-Cap’s ingestible capsule for colorectal cancer screening. The investigational system uses ultra–low-dose x-ray and wireless communication technologies to scan the inside of the … Read more

Inprinciple, the body reflects a banned presence in character, preserved and shielded against breach that might endanger life. It’s in most religions as well as in artificial moral and ethical code of legislation. It allows dividing the human anatomy ethics in treatment and operation by permission, on condition that interference in the body is bound … Read more

Friends and foes of “any-willing-provider” legislation don’t line up as predictably as they once did. And even in the states that have enacted such laws applying to physicians, AWP is turning out to be a less ferocious beast than its backers had hoped. “We’re not in favor of ‘any willing provider’ legislation because it is … Read more

Name Last modified Size Description Parent Directory 28-Aug-2000 11:10 – ../../../../archiveMC/9711/QNA.1.GIF 17-May-2000 12:21 1k 9711.compmon.shtml 17-May-2000 12:19 1k 9711.outlook.shtml 17-May-2000 12:20 1k 9711.editorsmemo.shtml 17-May-2000 12:19 2k 9711.contents.shtml 17-May-2000 12:19 4k 9711.news.shtml 17-May-2000 12:20 7k 9711.legal.shtml 17-May-2000 12:20 7k 9711.washington.shtml 17-May-2000 12:21 8k 9711.employer.shtml 17-May-2000 12:19 8k 9711.ethics.shtml 17-May-2000 12:20 8k 9711.states.shtml 17-May-2000 12:21 8k ../../../../archiveMC/9711/9711.compmon.ext.gif … Read more

Washington Watch Managed care legislation has replaced Medicare as the top health care legislative priority for both Congress and the White House, with presidential-election politics starting to enter the mix. The zeal to overhaul Medicare hit the skids after the Bipartisan Commission on Medicare Reform fell one vote short of making formal recommendations to Congress. … Read more

The Lone Star State may be a lone wolf when it comes to regulating virtual visits. When the Texas Medical Board adopted new rules governing the use of telemedicine in April, medical professionals sat up as if the series-ending episode of their favorite TV show just came on. Some see the rules as blocking telehealth. … Read more

MANAGED CARE November 2006. ©MediMedia USA This CMO of a pharmacy benefits manager wrestles with some of insurance’s most taxing issues. Price, of course. And here come biologics! James E. Hartert, MD, grew up in Winona, Minn., a river town about a hundred miles down the Mississippi River from metropolitan Minneapolis/St. Paul, where he now works. An … Read more

Mr. Henderson is 72. He is worried about his prostate. His biopsy came back equivocal and his MRI negative, and his wife wants him to have an operation instead of routine laboratory testing. Mr. Henderson has been married for 51 years and is with his wife in Dr. Beale’s office. “I don’t know, Doc. Maybe … Read more

Those who make deals between buyers and insurers are used to perks and tidy commissions. The Internet and defined contributions may threaten that. John Carroll PLAYERS When Tom Elkin decided to sign on as CEO of a start-up, not-for-profit HMO in California five years ago, he had every reason to feel confident in his knowledge … Read more

FDA Handling of Avastin Discourages Innovation Avastin cancer drugs evidence FDA There has been a lot of discussion of the Food and Drug Administration’s decision to revoke approval for the use of Avastin in metastatic breast cancer. Most of it takes at face value FDA Commissioner Margaret A. Hamburg’s 69- page decision in which she … Read more

More than a third of Americans who need to be screened for colon or breast cancer have not been screened, according to the latest report from the Centers for Disease Control and Prevention. But overall, more people are being screened than ever before. “We are encouraged by a significant increase in colon cancer screening rates … Read more

Forever Young Submitted by Steven Peskin MD on Fri, 2012-09-21 12:05 As a baby boomer moving through middle age into the unspeakable age that follows “middle,” I was encouraged to read an article in the British Medical Journal that states that for seniors and super seniors, healthy behaviors that include regular exercise, not smoking, maintaining a … Read more

Name Last modified Size Description Parent Directory 28-Aug-2000 11:10 – ../../../../archiveMC/9711/QNA.1.GIF 17-May-2000 12:21 1k 9711.compmon.shtml 17-May-2000 12:19 1k 9711.outlook.shtml 17-May-2000 12:20 1k 9711.editorsmemo.shtml 17-May-2000 12:19 2k 9711.contents.shtml 17-May-2000 12:19 4k 9711.news.shtml 17-May-2000 12:20 7k 9711.legal.shtml 17-May-2000 12:20 7k 9711.washington.shtml 17-May-2000 12:21 8k 9711.employer.shtml 17-May-2000 12:19 8k 9711.ethics.shtml 17-May-2000 12:20 8k 9711.states.shtml 17-May-2000 12:21 8k ../../../../archiveMC/9711/9711.compmon.ext.gif … Read more

Nearly all (96%) of U.S. hospitals use electronic health records (EHRs), and 85% share clinical data with other hospitals, according to new survey data from the American Hospital Association Information Technology Supplement. The report comes at the start of the annual meeting of the Office of the National Coordinator for Health Information Technology in Washington, … Read more

There’s still no “magic pill,” but new medications abound. With the disease uncontrolled in millions, it’s time to get utilization management just right. A report from the Pharmaceutical Research and Manufacturers Association (PhRMA) says there are 180 new medications in the pipeline for type 1 and type 2 diabetes. That number reflects the boundless therapeutic … Read more

Simponi Aria, a fully-human anti tumor necrosis factor (TNF)-alpha therapy, has been approved in 2013 for its treating mildly to severely active rheumatoid arthritis symptoms. The FDA’s enlarged concessions were encouraged by statistics in the Phase 3 Multicenter, randomized, doubleblind, multiple-choice research (GO-VIBRANT and GO-ALIVE) which comprised p 600 patients. Research workers were randomized to … Read more

More than half of shortages involved life-saving drugs Emergency departments (EDs) are health care’s front line — in the U.S., nearly 45 out of 100 people visit an ED in any given year. But there is an issue brewing behind the scenes in emergency medical facilities, one that can’t be fixed by a simple stitch … Read more

LOOKING FORWARD For other articles in the series, see listing at end Now that the hard part — forging quality-measurement systems for HMOs and point-of-service plans — has been done, the next step is to adapt these programs to the rest of the health care industry. Margaret E. O’Kane Twenty years ago, when fee-for-service practice … Read more

The PBM industry stands at the intersection of two recent blockbuster announcements. Mergers, acquisitions, and other activities have resulted in a growing number of health plans owning a PBM capability similar to Anthem’s in-house PBM IngenioRx. And the Trump administration proposed a rule to eliminate rebates from pharmaceutical companies to PBMs. While every stakeholder in … Read more

The IMS Institute for Healthcare Informatics reported a 2.3 percent increase in spending on prescription medications in 2010. That is markedly lower than the rate reported in 2009 — 5.1 percent. The total dollars spent on medications reached $307.4 billion last year — or real per capita spending of $898, up $6 from 2009. The … Read more

Medication makers have depended on coupons to elevate admittance to marked medications by decreasing patients’ cash based expenses. Safety net providers and PBMs, then again, have gone against coupons since they sabotage the viability of cost-sharing necessities and advantage plans that boost financially savvy drug endorsing and buying decisions. Copay coupons have been working up … Read more

Interest in consumer-directed health plans lost steam last year, with the number of employers offering such plans declining for the first time since 2007, according to United Benefits Advisors, a benefit survey organization. The 2012 UBA Health Plan Survey calls this a critical trend that its employer customers should consider “when making health plan purchasing … Read more

Some managed care companies begin to take a hard look at what’s behind the explosion in costs for radiological services Michael Levin-Epstein High-tech CT, MRI, and PET imaging machines make it possible for physicians to ferret out tumors, uncover ligament damage, and pinpoint blocked arteries, but they are not cheap. That is why radiology costs … Read more

Health plans have much at stake as Congress moves to lay down the do’s and don’ts about use of info gathered via genetic testing. Michael Levin-Epstein Managed care governmental affairs and medical directors have been monitoring federal genetic testing legislation for several years, but now, Hill insiders say, with the unanimous passage of the Genetic … Read more

Unable to find an acceptable suitor for HIP Health Plan of New Jersey, state officials on March 31 closed the deeply indebted HMO they seized late last year and are liquidating its assets. Regulators ordered other HMOs in the state to accept HIP’s 144,000 commercial subscribers without regard to existing medical conditions. Last month, a … Read more

They are part of PPACA’s effort to cover as many people as possible. Insurers will be forced to remake their businesses. The Patient Protection and Affordable Care Act (PPACA) is designed to expand health insurance coverage to people who fall into the cracks — people who are jobless or self-employed, who can’t buy insurance because … Read more

Azar’s response: “We will bring down prescription drug prices” President Donald Trump said prescription drug prices will come “rocketing down” under the leadership of the new secretary of Health and Social Services (HHS), according to a report from The Hill. “We have to get the prices of prescription drugs way down and unravel the tangled web … Read more

Risk adjustment is part of the reform package, but other countries have had problems with implementation Richard Mark Kirkner MANAGED CARE April 2010. ©MediMedia USA Risk adjustment is part of the reform package, but other countries have had problems with implementation Richard Mark Kirkner It may have been pure coincidence that as congressional debate on the massive … Read more

CONTRIBUTING VOICES There are people who think health care costs are about to decrease! John Marcille I was just looking at the website of Newtek Business Services (www.thesba.com/), which also goes by the name of The Small Business Authority. It sells financial and administrative services to small businesses. I found more evidence that the public … Read more

Full text in PDF ABSTRACT Objective: Several antifungal agents are indicated for onychomycosis, a fungal infection of the toenails and fingernails. These agents differ in their dosing regimen, efficacy, adverse events profile, potential for drug interaction, and cost. We conducted a pharmacoeconomic analysis of oral and topical therapies for onychomycosis from the perspective of a hypothetical … Read more

New hepatitis C medications fuel rising costs The Kaiser Family Foundation has examined trends in Medicare spending on prescription drugs, how Medicare coverage affects beneficiary access and costs, and what the public thinks about different options for keeping drug costs down. The foundation found that total and per capita Part D spending has increased rapidly … Read more

MEDICATION MANAGEMENT Cancer Agents Taken Orally Pose Adherence Problems Despite Ease of Administration The regimens can be complex. PBMs use education, outreach, split fills, and other techniques to help with adherence. Oral chemotherapy drugs have transformed cancer care. Agents such as imatinib (Gleevec) opened the door to long-term remission in chronic myelogenous leukemia (CML). Since … Read more

BY NEIL CAESAR, J.D. From time to time we have discussed how important it is for physicians to consider the Ethics in Patient Referral Act (the so-called Stark law) when crafting an income division or compensation formula. This law prohibits physicians from dividing income among themselves in a way that tracks their utilization of certain … Read more

Approval decision scheduled for June The FDA’s Oncologic Drugs Advisory Committee has voted unanimously (11 to 0) that the risk–benefit ratio of rituximab/hyaluronidase for subcutaneous (SC) injection (Halozyme Therapeutics) was favorable for patients in the proposed indications of follicular lymphoma, diffuse large B-cell lymphoma, and chronic lymphocytic leukemia. The FDA action date is June 26, … Read more

A physician-turned-academic-researcher builds a framework for challenging the health system’s focus on specialists For someone who would like to see the American health care system change almost completely, from a system dominated by specialty care to one that has primary care with appropriate secondary care backup as its core, Barbara Starfield, MD, MPH, spends a … Read more

Will Automated Records Be Worth Their Price? How Plans are Building Electronic Patient Charts Computerized clinical records can give a health care plan a competitive edge, but implementation is challenging. Some institutions are closing in on the automated patient record; others have miles to go. Why Managed Care Is Getting A Bad Rap Open a … Read more

MANAGED CARE February 2005. ©MediMedia USA The skinny on why data used by the Centers for Disease Control and Prevention exaggerated the number of obesity-related deaths is that a computer error caused a CDC study to overstate the number by 35,000. Four agency researchers reported in the Journal of the American Medical Association that a software glitch … Read more

More and more, PPOs are coming under scrutiny, according to InterStudy Publications, which found that 40 states have passed some level of PPO regulation. That’s a big increase since 1992, when only a dozen states had regulations specific to PPOs…. Cost remains the major factor that small employers weigh when deciding whether to offer benefits, … Read more

This month, hospitals and physicians in the second wave of applicants to CMS’s Bundled Payments for Care Improvement Advanced (BPCI-A) model are deciding whether to take the plunge. In late September, CMS provided four years’ worth of claims data to applicants, who have until December 1 to look the information over and decide whether to … Read more

There have been no novel medications for decades, and exisiting therapies don’t have enough of an impact on morbidity and mortality rates The clinical guidelines for the treatment of heart failure were completely revised by the American College of Cardiology Foundation and the American Heart Association (ACCF/AHA), to emphasize the role of medication therapy as … Read more

Advanced therapy management may lead to physician acceptance of additional medications infused at home Home infusion has been around for over 30 years, but it is a service that has never really taken off. Effective infusion drugs have been developed for acute conditions, but home infusion has been relegated to less glamorous uses such as … Read more

The voters have spoken: “Fix Medicare without shortchanging Grandma (or gutting the system before we can benefit) and do something about the uninsured.” But by returning a Democratic president to joust with a Republican Congress, the voters have made it likely that such beloved perennials as Medicare and health care reform will progress with all … Read more

The question facing health care organizations today is daunting: “How are we going to efficiently and effectively care for millions of new patients, many with chronic illnesses, and many who have never had access to routine health care in the past?” At Franciscan Health System in Tacoma, Washington, we face the same problems as other … Read more

Although the controversial medical savings account concept lost a staunch congressional supporter with Senator Robert Dole’s announced resignation from the Senate, the next step for the pending health reform measure–a House-Senate con- ference committee–has not changed. The conferees had not been appointed at this writing, but composition of the conference committee is of sharp importance … Read more

In a rare admission, the president and chief executive officer of Aetna U.S. Healthcare says that when it came to contract negotiations, the insurer played too much hardball with physicians in Texas. The company’s contracting tactics fueled a physician backlash that led several groups in the state to walk away from the HMO when their … Read more

The study detected over 7,020 adults who have type two diabetes using a proven history of coronary illness carrying Jardiance along with this”quality of care” for cardiovascular disease hazard loss and diabetes maintenance. Advisory panel members believed that the solid decrease in premature death passing through the trial was persuasive. But a few participants had … Read more

Psychogenesis and Health Reform 2.0 Recently a Minnesota school was evacuated after 10 students got sick during choir practice. A carbon monoxide leak was the presumed cause, given the similarity of student’s symptoms and the rapid spread of complaints. Thirty students in all were taken to the hospital and the school was closed for the … Read more

Name Last modified Size Description Parent Directory 04-Jan-98 21:46 – MC9606.buyin.shtml 24-Nov-97 22:51 7k ../../archiveMC/9606/MC9606.compmon.gif 16-Mar-97 22:47 48k MC9606.compmon.shtml 24-Nov-97 22:51 1k MC9606.contents.shtml 24-Nov-97 22:51 3k MC9606.corporate.shtml 24-Nov-97 22:51 22k ../../archiveMC/9606/MC9606.cover.jpg 16-Mar-97 22:47 15k MC9606.editorsmemo.sh..24-Nov-97 22:51 3k MC9606.employer.shtml 24-Nov-97 22:50 9k MC9606.ethics.shtml 24-Nov-97 22:50 8k MC9606.food.shtml 24-Nov-97 22:50 29k MC9606.guidelines.shtml24-Nov-97 22:50 4k MC9606.legal.shtml 24-Nov-97 22:50 … Read more

As expensive products increase their share of the medication market, expect these methods to be employed widely Ira Studin, PhD, MPH Escalating specialty pharmacy (SP) costs, together with a mixed picture on long term effectiveness and problems of adherence, will make it necessary for insurers to rely more heavily on traditional managed care methods to … Read more

Some physicians are putting new emphasis on careful, active listening to patients. Organizations that don’t encourage this may be ignoring a tool for controlling costs, retaining enrollment and improving medical care. Listen to the patient: He is telling you the diagnosis,” Sir William Osler counseled his fellow physicians at the dawn of the 20th century. … Read more

Federal Report: Theranos Blood-Testing Devices Often Failed Accuracy Requirements The blood-testing devices that Theranos Inc. has touted as revolutionary often failed to meet the company’s own accuracy requirements for a range of tests, including one to help detect cancer, according to an article in the Wall Street Journal. The Journal got an early look at a federal report detailing … Read more

By Jean Lawrence Contributing Editor Female patient, 52, calls her HMO for a well-woman appointment. “Nothing available for three weeks.” “I’d like to come sooner,” she tells the clerk. “I haven’t met my deductible under my HMO/medical savings account coverage and will be paying cash. Will the clerk take another look in the book?” Or … Read more

Peer-viewed studies and review articles on managed care. ORIGINAL RESEARCH Cost Effectiveness of the Insertion of Hydrogel Spacer in Men Treated With Radiation Therapy for Prostate Cancer ABSTRACT  Purpose: The study examined the cost effectiveness of prostate cancer radiotherapy with and without the use of a hydrogel spacer. Design and Methodology: Retrospective data from Truven … Read more

Physician demand may finally be on the horizon. The only question is whether the personal digital assistant, smart phone, or another variety will dominate. Joyce Ochs, MBA It appears that physicians are joining other professionals who find the ubiquitous PDA (personal digital assistant) to be indispensable. Data from Manhattan Research, a health care and life … Read more

MANAGED CARE November 2007. ©MediMedia USA Microsoft has entered the consumer health care market with a free personal health record on the Web («http://www.healthvault.com/»). HealthVault will store, collect, and distribute private health information that can be shared with a physician, a clinic, or a hospital. Information that can be shared includes what medications the individual takes and … Read more

Your typical American family of four is going to have $15,609 in medical expenses this year. That’s an increase of more than $1,100 from last year. That number is reported in the fourth annual Milliman Medical Index (MMI), which tracks the average yearly health care costs when the family of four is covered by an … Read more

P&T Digest: Pain Management Randall P. Brewer, MD, Chief Medical Editor Chronic pain is a significant public health issue in the United States and an important concern for MCOs. Untreated or undertreated pain can evolve from a symptom to a chronic condition in its own right, one that has serious comorbid, economic, and quality-of-life consequences. … Read more

These niche operators might help to keep hospital costs down and prevent some hospital-acquired conditions Asked if there is, in fact, such a thing as a proceduralist, Bradley T. Rosen, MD, the assistant director of the procedure center at Cedars-Sinai Medical Center, responds that the query is “very existential,” since he is one himself. Still, … Read more

The backlash has helped push a Patients’ Bill of Rights forward, challenging the very nature of cost containment. Ironically, enrollees may be shortchanged. Frank Diamond Senior Editor When the Senate passed the Patients’ Bill of Rights on June 29, many politicians and reporters were quick to see this as a major victory for the downtrodden … Read more

Attention home-health agencies: In a major policy shift, the Health Care Financing Administration no longer will treat as “new” any agency that otherwise would qualify as “old” if not for the fact that it changed its organizational status from freestanding to hospital-based (or vice-versa) after fiscal 1994. As a result, revisions to the per-visit and … Read more

Back in mid-May, a pair of congressmen from Texas representing both sides of the aisle put forward a new piece of old legislation. Their Health Care Price Transparency Promotion Act of 2012 directs states to mandate hospitals to shine a light on their price list for services. The Republican, Michael Burgess, and his Democratic counterpart, … Read more

Scientists at the Wellcome Trust Sanger Institute in Cambridge, United Kingdom, and their international collaborators have shown that acute myeloid leukemia (AML) is not a single disorder, but at least 11 different diseases, and that genetic changes explain differences in survival among young AML patients. Published in the New England Journal of Medicine, the groundbreaking study … Read more

CDHPs and catastrophic insurance plans can save consumers money, but do high deductibles add to overall costs down the line? The rising cost of health insurance premiums for employers — up 131 percent in the last decade, to an average $13,375 per year for family coverage, according to the Kaiser Family Foundation — has led to … Read more

As some pretty costly, yet very useful, drugs are introduced, will new formulary designs deny access to needy patients? Last year, one of the managed care clients that works with the advisers at Towers Perrin had a single member whose drug bill topped a million dollars. It’s the kind of money that quickly captures a … Read more

Presenteeism — the condition of being on the job, but giving less than 100 percent — is fertile ground for health plans with a suitable product. MargaretAnn Cross Contributing Editor About 100 physicians in South Charleston, W.Va., have been offered a stake in keeping 10,000 Dow Chemical employees as productive as they can be. By … Read more

In response to the expense of new migraine therapies, treatment practices aimed at controlling direct costs are now the norm. Full text of this article is available in PDF. Abstract Migraine headache is a disabling disease that poses a significant societal burden. Stratified care and early intervention are current strategies for migraine management. It has … Read more

We invited experts from around the country to weigh in on the strengths and weaknesses of Hospital at Home and what would be required for the concept to succeed in nonintegrated health care settings. These are responses to our cover story: Hospital at Home Saves 19% In Real-World Study Caring for the Whole Patient in the … Read more

Washington Initiatives The Senate approved a bill that requires federal-employee health plans to cover prescription contraceptives. The introduction of the arousal drug Viagra — and its subsequent (but often limited) coverage by many health plans — spurred women’s groups to press Congress to pass legislation mandating reimbursement for contraceptives. The Senate passed the measure 91–5, … Read more

The rate of increase for medical costs and prescription drugs are projected to decline in 2008, according to the Segal Health Plan Cost Trend Survey. This marks the fifth consecutive year of slower rates of increases for medical claims. Meanwhile, the rise in the costs for prescription drug coverage has slowed at about the same … Read more

The opening murmurs in negotiations between health plans and large employers have been heard. Insurers are expected to seek an average 13.7 percent hike in premiums in 2005, according to a survey of 160 large employers by Hewitt Associates. Again, that’s an average, not a consensus. Different insurers will ask for different increases. For instance, … Read more

It has not been easy to launch the massive HealthConnect system, but officials at the health plan say it has been rewarding   Talk to Louise Lang, MD, the executive vice president for clinical systems and quality at Kaiser Permanente, about how the health plan managed to install what it calls the biggest electronic medical … Read more

Disease Management Uses Web To Net Savings More vendors are turning to the Internet to expand the reach of programs. Cutting-edge technology helps patients help themselves. Charles Downey Oregon Attempts To Blaze Trail With ‘Reference-Based’ Formulary Pharmaceutical makers invest enormous sums in R&D – but they also reap enormous profits. States are impatient with the … Read more

The Melody Transcatheter Pulmonary Valve is delivered through cardiac catheterization, a favorable alternative to chest surgery Congenital defects of the heart and great vessels, among the most common congenital malformations, affect about 1 percent of live births. There are a few recognized causes of these defects, such as German measles (rubella), which affects the developing … Read more

Despite all the talk about HIPAA privacy protections, there was little action. New regulations are intended to ensure compliance. When legislators pieced together new provisions for the Health Insurance Portability and Accountability Act early this year in the American Recovery and Reinvestment Act of 2009 (the stimulus), they erected a complex set of legal hurdles … Read more

There’s a low-key war going on between community pharmacies and the big guys that offer drugs by mail. Is this about money or medicine? Linda is a 51-year-old woman on maintenance estrogen and medication for hypertension. When she mentions the cost, her primary care physician suggests she try her HMO’s mail-order option and get three … Read more

Women hold a 30 percent greater share of physician executive jobs than they did 10 years ago, according to the “2007 Physician Executive Compensation Survey” conducted by the American College of Physician Executives and Cejka Search. Forty percent of those women held the title of medical director. Thirty percent is a large increase, but the … Read more

The Hay Group’s annual benefits report found that health insurance premiums rose 5.2 percent in 1999, but not necessarily because insurers were trying to boost their bottom lines. Rather, the consulting firm attributes most of that rise to the soaring cost of prescription drugs — up 15 percent, by Hay’s estimate. Though the year began … Read more

The current underwriting cycle is long in the tooth, but experts still see profitability ahead The laws of physics make clear that what goes up must come down. But recent history suggests that the underwriting cycle for health insurance may prove to be an exception — we no longer know exactly when, or if, those … Read more

Health plans are taking profitable cues from national retailers and providing members with coupons for newly available over-the-counter products. Blue Care Network (BCN) of Michigan is taking its cue from the retail ranks of CVS, Rite Aid, ShopRite, and Target by providing coupon savings to its allergy sufferers. It is a growing trend among other … Read more

Spurred from the Inexpensive Treatment Act (ACA), Healthcare associations Are under some great pressure to develop the overall protection, affordability and caliber of individual attention. Over earlier, suppliers are predicted to supply worth –which will be, enhanced high excellent with restricted fees –during discounts in depreciation. To model the transition, then the Division of Health … Read more

An early managed care idea that the marketplace once rejected is now being embraced by employers and offered by health plans In the 2011 movie Moneyball, the general manager of the Oakland A’s is portrayed as one of the smartest executives in baseball. A former player and first-round draft choice, GM Billy Beane pores over … Read more

The importance of a gatekeeper in keeping costs down has been challenged again — this time in a study that compares physician utilization for HMOs and point-of-service plans. The study, sponsored by the U.S. Agency for Healthcare Research and Quality, found no evidence that HMOs that use primary care physicians as gatekeepers keep specialty costs … Read more

Cost increases for health services should lessen for both employers and the health insurance plans that serve them in 2008, according to two major consulting companies. Employers can expect to see single-digit increases in what it costs to provide coverage to their workers next year, according to a study by PricewaterhouseCoopers. Findings are based on … Read more

Despite some slowing in the trend, employers can still expect to face the fifth straight year of double-digit increases for employee health care benefits. Towers Perrin surveyed 200 businesses with an average workforce of 7,200 to find that a 12-percent increase in costs is expected in 2004. It’s little consolation that the figure is smaller … Read more

Eight of the country’s largest companies have created a group whose purpose is to exhort employers to insist on safe medicine when doing business with health plans, and to encourage workers to use hospitals with good safety records. The Leapfrog Group grew out of the Institute of Medicine’s report detailing medical mistakes in hospitals. The … Read more

The association between the two diseases is strong, and insurers should consider all management options The association between diabetes and depression is often overlooked, but insurers are in a good position to expand screening. An Express Scripts study of drug utilization across the country found that the highest prevalence of mental health medication use, at … Read more

Prescription benefit arrangements between physicians and managed care companies seem to be a growing trend replete with growing pains. In 1995, Harris Methodist Health Plan, the largest in northern Texas, informed the Fort Worth Clinic and its physicians that they were to spend no more than 9.6 percent of each premium dollar on drugs. If … Read more

Cleveland Clinic and Also Oscar will Enlarge their co-branded Wellbeing The choice to enlarge comes following an effective start to this Venture, which started in 2018, signaling Cleveland Clinic’s first entrance into the medical insurance market using something bearing its own name. “Oscar’s venture with Cleveland Clinic Obviously shows What’s potential when payers and providers … Read more

The 2003 WilsonRx Survey reports that patients have identified Medco Health Solutions as the top pharmacy benefit manager for the third year in a row. Reported satisfaction was less for AdvancePCS, Aetna, Anthem, Caremark, Eckerd Health Services, Express Scripts, Prescription Solutions, RxPrime, Walgreens Health Initiatives, United Healthcare, and WellPoint Pharmacy Management. Wilson Health Information researches … Read more

Health plans seek drug review summaries from other plans, vendors, and online sources MargaretAnn Cross Contributing Editor The two dozen medical professionals who make up the pharmacy and therapeutics committee for the Hawaii Medical Service Association are striving to make formulary decisions based on the best evidence available. And like all health plans, the Blue … Read more

Better-informed patients need not be a bane to other players in the health care industry. Interaction doesn’t have to be adversarial and should include the historical “have-nots.” Four themes will continue to grow in importance as the shift to consumer and patient empowerment continues into the 21st century. Consumers will want more and better information so … Read more

Since the identification of this DNA double-stranded helix, the receptor for a target of therapy and, more over, using DNA for a medication have now already been chances. ‘Antisense’ can be employed by a few living organisms, namely viruses, to restrain gene replication. Only recently, using antisense DNA for a mechanism to restrain human anatomy … Read more

In reaction to practitioner and patient demand and increasing signs of its importance in looking after the sickest and most vulnerable patients while in america medical care procedure. The incidence of hospital-based PC services has risen by 26% in recent years; 67 percent of most hospitals and more than 90 percent of hospitals with over … Read more

Printer-friendly version Managed Medicare and Medicaid especially struggle to develop improved discharge and follow-up systems While Congress looks to wring billions of dollars out of the nation’s health care system, America’s health insurers believe billions may be saved simply by improving hospital discharges so that patients do not return. Some health plans have been working … Read more

Feds ready rapid-response teams Mosquitoes that transmit the Zika virus live in nearly all of the continental United States, according to new maps released by the Centers for Disease Control and Prevention (CDC). The maps show that two breeds of virus-carrying mosquitoes—Aedes aegypti and Ae. Albopictus—can be found as far north as Michigan, New Hampshire, and Washington … Read more

Despite the extensive attention paid to consumer-directed health plans, a survey conducted by the Kaiser Family Foundation shows that these types of plan arrangements have made only small inroads in the employer market. Such plans cover about 5 percent of all covered workers, which is not statistically different from the 4 percent share recorded in … Read more

Though the Department of Health and Human Services and Department of Labor issued final regulations concerning “Incentives for Nondiscriminatory Wellness Programs in Group Health Plans,”1 employers and health plans must still navigate unresolved inconsistencies between the Affordable Care Act (ACA) and the Americans with Disabilities Act (ADA). The latest ACA rules indicate that if a plan … Read more

Accountable care organizations and patient-centered medical homes are unlikely to succeed. Those are two predictions from Regina E. Herzlinger, a professor at the Harvard Business School who has successfully predicted some of the most powerful trends in health care since the 1990s. Arguably, most of her predictions about health care have come true or are … Read more

We’ve known Michael O’Donnell, the publisher and editor in chief of the American Journal of Health Promotion, for 30 years. He is not prone to hyperbole. So he got our attention when he recently wrote that he had just published “the most extensive and well-conceived review conducted to date” on the financial impact of workplace health promotion. … Read more

Only Medicare has the heft and reach to make cancer services more value-based, and recent reforms aim to do just that. Insurers keep close watch. For years now, national health plans such as UnitedHealthcare, Aetna, Cigna, and Anthem have been experimenting with clinical pathways, oncology medical homes, and episode payment arrangements to eliminate unnecessary variation … Read more

Name Last modified Size Description Parent Directory 26-Jul-2000 21:05 – 9808.washington_thom..> 29-May-2000 11:54 2k 9808.washington_tele..> 29-May-2000 11:54 1k 9808.washington_take..> 29-May-2000 11:54 2k 9808.washington_some..> 29-May-2000 11:54 1k 9808.washington_medp..> 29-May-2000 11:54 2k 9808.washington_gord..> 29-May-2000 11:54 1k 9808.washington_desp..> 29-May-2000 11:54 3k 9808.truce_gatechart..> 06-Jul-1999 09:06 16k 9808.truce.shtml 29-May-2000 11:53 24k 9808.states_texas.shtml 29-May-2000 11:53 2k 9808.states_statesde..> 29-May-2000 11:53 3k 9808.states_kentucky..> … Read more

Chronic nonmalignant pain demands treatment and evaluation different from severe pain. The pathophysiology differs, and there’s often a level of ed disorder. Since they’re self-reinforcing, opioids might be hunted and also be reported to boost chronic pain, even if they can make the condition worse during the time. There are lots of effective alternatives to … Read more

Complaint Rates On Indiana’s HMOs Available Online Indiana’s insurance department has posted information about consumer complaints against HMOs and other health insurers on the Internet. The number of complaints filed against each plan and resolved is provided, along with a “complaint index” that compares the plan’s percentage of all complaints to its market share in … Read more

Well-Being and the Next Industrial Revolution There was a moment at the recent “Health Matters Summit” hosted by The Clinton Foundation that in years past would have struck me as totally implausible. President Clinton was chairing a panel of experts for a session titled, “The Quest for Longevity and Our Rising Death Rates.” Reginald Eadie, … Read more

Patients may soon need an appointment to see a pharmacist. If trends continue, community pharmacists will join the ranks of physician extenders, getting paid to provide patient care. Exactly what kind of care is still up for grabs, but a role in disease management looks like a good bet. At least, that’s what the Health … Read more

During one week last October, thousands of pharmacies around the country placed frantic calls to PCS Health Systems, the pharmacy benefit manager. They were looking for $200 million in reimbursement checks that should have gone out the previous Friday. What callers heard was a brief statement to the effect that PCS had changed its annual … Read more

PCORI Won’t Be NICE Some hope that the Patient Centered Outcomes Research Institute (PCORI) might evolve into something like the United Kingdom’s National Institute for Health and Care Excellence (NICE). Not going to happen, says David B. Nash, MD, MBA, the founding dean of the Jefferson School of Population Health at Thomas Jefferson University in … Read more

For all the rapid change in health care in the 1990s, some things will remain unchanged from 1990 to 2000, according to one recent analysis. The percentages of the market claimed by preferred-provider organizations and–perhaps surprisingly–by unmanaged fee-for-service medicine will finish the decade about where they started it, the analysis suggests. But HMOs and point-of-service … Read more

Jerome D. Cohen, MD Department of Internal Medicine (Cardiology), St. Louis University School of Medicine Full text in PDF Abstract Background: Hypertension (HTN) continues to be a serious public health problem in the United States and is a major risk factor for stroke, heart failure, myocardial infarction, and other serious cardiovascular and renal diseases. Because HTN … Read more

The estimates range from $13.5 trillion to $47.6 trillion. The variables include the generosity of the benefit and forecasts for reining in health care expenditures. As the former chief economist at the International Monetary Fund, Simon Johnson has done his share of broad-scale economic forecasting. Now a professor at MIT, he and other experts were … Read more

WellPoint and Cigna are turning heads in the financial world. Cigna’s second-quarter earnings rose 73 percent from the same period last year to $720 million as its earnings kept well ahead of medical costs thanks to higher premiums and lower operating costs, reports the Wall Street Journal. Meanwhile, the newspaper says that WellPoint’s earnings are … Read more

Gastric adenocarcinomas are basically named cardia and non-cardia dependent on their anatomic site. Malignancies of the gastric cardia emerge in the locale bordering the esophageal-gastric intersection and in this manner share epidemiological qualities with esophageal adenocarcinoma (EAC). Non-cardia malignancy, otherwise called distal stomach disease, is more normal and emerges in the lower bit of the … Read more

Medicare needs a financial fix, and needs it badly. That fact hasn’t escaped the attention of any headline-browser in recent months. President Clinton and Republican congressional leaders have agreed on the outlines of a budget agreement that would cut the growth of the $170 billion annual program by $115 billion over five years. But the … Read more

A new law that makes employers extend health benefits to about a million uninsured Californians will be watched carefully. Opponents of the law, signed by Gov. Gray Davis two days before the recall vote that ousted him, vow to challenge it in the courts. “The California Chamber [of Commerce] agrees that uninsured Californians need help, … Read more

Their care of loved ones defrays costs that would otherwise have to be borne by the health care system, but they too often go it alone. Anna Boyle is struggling to figure out how to care for her mother. After a string of health issues put Doris Boyle in and out of Boyle’s care for … Read more

Financial analysts warn against judging FPA Medical Management’s slide into bankruptcy as the general direction of the physician practice management industry. Said one, wide variations in business strategy make generalizations unrealistic. The consensus about FPA is that it grew too fast. FPA has fallen hard; its stock price, which was around $40 a share last … Read more

Every year, it seemed, I heard at least one speaker at some conference who lamented that managed care companies spent far less than their brothers in other industries, and that this was shortsighted. It sounded reasonable. After all, if “managing” is what a managed care organization does, if it doesn’t just pay the bills, the … Read more

Less Carrot, More Stick? How Some HMOs Go Too Far There’s a line between encouragement and coercion that doctors say some health plans ignore. Given physician defensiveness, can any approach to DM work? Does capitation make effective buy-in nearly impossible? Show Me The Outcomes! Valid outcomes studies in disease management are elusive. Which are good? … Read more

Now that we know there is so much unwarranted deviation in care, payers are promoting comparative effectiveness research and other efforts to help providers embrace the evidence Barry Patel, PharmD, is on a mission to improve the delivery of health care, one physician at a time. His company, Total Therapeutic Management, hires physicians, pharmacists, nurses, … Read more

Back in 1991, the planet’s 2nd wealthiest person griped about healthcare expenses. Now, Sam Walton’s wal-mart empire is striking back together with lead contracting. The retail giant is currently using centers-of-excellence contracts through that it pays high-value carrier businesses to take care of special medical issues. The reduction store behemoth has ever had a reputation … Read more

A Deloitte & Touche study has added fuel to an argument the health insurance industry has advanced of late: When stacked against other issues, health care barely rates a yawn. The survey, conducted in conjunction with the International Society of Certified Employee Benefit Specialists, suggests that retirement planning is a far more pressing issue than … Read more

PacifiCare says it isn’t necessarily for sale, but won’t rule one out, either, as it examines “value-increasing strategies.” PacifiCare’s soul-searching, prompted by a 43-percent decline in its stock price this year, officially began on a November day when it shook up management and formed an executive committee to sift the company’s options. PacifiCare President Jeffrey … Read more

Dangling Dollars Health plans are using financial incentives to encourage members to pick lower-cost providers. Some worry that cutting checks will crowd out quality. Joseph Burns New Era of Health Care Spending Could Roll Into the Good Times The slowdown in increases often happens during and shortly after recessions, but this time the trend may … Read more

The Stark II regulations allow many forms of physician compensation, as long as they are “commercially reasonable.” But the ambiguity of the law may spur some concern among physicians, who must try to determine how that phrase will be defined. This requirement shows up under Stark II’s approvals of employment relationships, isolated transactions, space rentals, … Read more

A study by the Rand Corp. suggests that high managed care penetration in urban areas is forcing a slow but tangible physician migration to the country — away from HMOs. Rand followed 75,000 doctors who finished graduate medical education between 1989 and 1994. Early in the period, primary care physicians tended to settle in metropolitan … Read more

Name Last modified Size Description Parent Directory 30-Dec-2000 15:10 – ../../../archiveMC/9711/9711.addyears_large.gif 02-Jan-2001 00:08 17k ../../../archiveMC/9711/9711.addyears_small.gif 02-Jan-2001 00:08 11k 9711.amap.shtml 02-Jan-2001 00:08 9k 9711.capitation_part..> 02-Jan-2001 00:08 19k 9711.capitation_part..> 02-Jan-2001 00:08 18k 9711.capitation_part..> 02-Jan-2001 00:08 9k 9711.compass.map.gif 02-Jan-2001 00:09 15k 9711.compass.nationa..> 02-Jan-2001 00:09 15k ../../../archiveMC/9711/9711.compass.pdf 02-Jan-2001 00:09 155k 9711.compass.regions..> 02-Jan-2001 00:09 28k 9711.compass.reportc..> 02-Jan-2001 00:10 30k 9711.compass.shtml … Read more

Health plans are drawing on existing benefits language to make coverage decisions about mifepristone, the newly approved abortion pill. The pill is administered directly by prescribers, so it is not treated as a pharmacy benefit. Among others, PacifiCare, Aetna U.S. Healthcare, Cigna, and United HealthCare cover mifepristone (also known as RU-486) as a standard medical … Read more

Health plans weigh whether giving up control of the conversation with patients is worth all the possible benefits Do you tweet? Are you linked in? Have you been tagged, or viewed? These days, social media sites such as Twitter, LinkedIn, and Facebook are all the rage, with insurers like WellPoint and Humana slowly getting into … Read more

The government wants to build an electronic system through which insurers, physicians, and hospitals can communicate. Snomed CT may solve a lot of problems. John Carroll Medical directors often complain that gathering health care data can be prohibitively expensive and severely hobbled by a conflicting set of competing electronic languages. But that may be about … Read more

Normal rulemaking and household patterns can grow to be nearly impossible, based on the form and seriousness of your child’s symptoms, and that means you will need to embrace various approaches. It may get frustrating to deal with a number of the behaviours that derive from the child’s ADHD, however there are means to make … Read more

Medicare’s Value-Based Purchasing Program Makes hospitals Based on worth of maintenance given. Multilevel random coefficient models estimated significance and mean of TPS differences from financial year 2015 and FY 20-16, by hospital type. In general mean TPS for 2985 hospitals dropped from 41.65 into 40.25. POSH and Kaiser Hospitals had substantially higher TPS at FY … Read more

States will have a wide latitude in determining what constitutes an essential benefits package that insurers who wish to participate in exchanges will need to start offering in 2014. In a move that may make an uncertain situation even more uncertain, the Obama administration on December 16 issued guidance on what states can demand from … Read more

The front page of the New York Times on Sunday, Sept. 5, carried a report that suggested that former Surgeon General C. Everett Koop’s reputation for integrity and honesty is being tested by his relationship with DrKoop.com, of which he is president. What are Koop’s alleged violations? His contract with DrKoop.com called for pocketing 2 … Read more

The next time Kaiser Permanente comes to CalPERS with its hat in its hand, it may have to be very persuasive. Kaiser’s HMO turned a $56 million first-quarter profit — its first quarter in the black in two years. Kaiser’s turnaround — it lost $881 million in 1997 and ’98 — is due to premium … Read more

Risk Adjustment: Immature System Heads for Big Time Health care stakeholders will be watching when HCFA installs a risk-adjustment methodology for Medicare+Choice. Could such a system work in the private sector? Who would gain? Lose? A New Model For Managing Care At least in California, HMOs are becoming superfluous, says one physician who sees them … Read more

Baby step by baby step, CMS seems determined to get away from the perverse incentives —and disincentives—associated with fee-for-service medicine. Medicare’s Chronic Care Management (CCM) payments, intended to encourage greater care coordination, is the agency’s latest move toward a post–fee-for-service world. The distribution of multiple chronic conditions People with multiple chronic conditions are a challenge … Read more

Managed care has wrung about all of the excess from the health care system that it can — and as a result, health care spending is about to jump dramatically, says the Health Care Financing Administration. In a study released in the September/October issue of the journal Health Affairs, HCFA actuaries credit the rise of … Read more

John M. Eisenberg, MD, MBA, the director of the federal Agency for Healthcare Research and Quality, died March 10, of a brain tumor. He was 55. Eisenberg was named AHRQ’s director in 1997 (when the agency was still known as the Agency for Health Care Policy and Research), becoming the point man for the federal … Read more

Confounding conventional wisdom, researchers writing in the New England Journal of Medicine have found that the spread of managed care during the past decade has not reduced the amount of time spent with patients. In fact, physicians in 1998 spent one to two more minutes with patients than in 1989, when managed care’s rapid expansion … Read more

Help-wanted : 911 Dispatcher. Applicants have to be readily irritated by 911 callers; telephone communication and swearing an advantage. Preference will be given to applicants in a position to whine in their workload whilst receiving calls. Punctuality and decent attendance aren’t mandatory, however working overtime is indispensable. The successful candidate should be expecting to get … Read more

Should they truly are buying inventory, then it’s generally a bullish progress. Here, we’re likely to highlight multiple manager purchases in Future PLC.. Future Publish articles such as tech, entertainment and gaming, songs, photography and creative, dwelling interest, instruction, tv and B2B industries chiefly in the USA and uk. Centene Corporation acts as a diversified … Read more

Good news for government workers enrolled in the Federal Employees Health Benefits Program. Premiums are expected to increase 7.9 percent next year. This after five consecutive years of double-digit hikes…. PPO demonstration projects for Medicare in 2001 and 2002 may have benefited by CMS officials exceeding their legislative authority, according to a General Accounting Office … Read more

At least 40% of office-based physicians have a basic electronic health record (EHR) system, but they are unable to do some of the functions necessary for meeting stage 1 of the federal meaningful use objectives, according to a report by the Robert Wood Johnson Foundation (http://tinyurl.com/RWJ-report). There are 15 core objectives in stage 1 that … Read more

Premera’s method of analyzing the potential benefits of Byetta shows how third-party modeling can pinpoint which members can benefit from easier access — and how plans can determine authentic cost savings John Carroll Contributing Editor John Watkins, RPh, the pharmacy manager in charge of formulary development at Premera Blue Cross, clearly recalls the first reaction … Read more

Flash Player 9 Version Test Download Flash Paul LendnerPaul Lendner ist ein praktizierender Experte im Bereich Gesundheit, Medizin und Fitness. Er schreibt bereits seit über 5 Jahren für das Managed Care Mag. Mit seinen Artikeln, die einen einzigartigen Expertenstatus nachweisen, liefert er unseren Lesern nicht nur Mehrwert, sondern auch Hilfestellung bei ihren Problemen. www.managedcaremag.com

Interim statistics reported here are out of 10 HBV-infected patients that performed week or two of once-a-day oral dosing of 25 milligrams of CMX157, and also 2 HBV patients treated for fourteen days of oral dosing using 300 mg TDF. Even the CMX157 treated patients revealed the average 99% decrease in HBV viral load when … Read more

Mimi Chen, PharmD, is a Clinical Services Manager at MediMedia Managed Markets and a part-time community pharmacist. In a time of deep partisan division, the 21st Century Cures Act stands out as an exception to the rule. The law passed late last year with broad support from both Democrats and Republicans and was signed into law … Read more

UnitedHealth Group provides a desirable service to providers in a pilot program in which patients who don’t pay medical bills on time will have the money deducted from their paychecks or health savings accounts. The insurer says that it is offering a convenient way for consumers to pay deductibles and copayments to providers in an … Read more

Plans will have to be careful about how incentives are structured. Doctors will need to be convinced that intentions are pure. John Carroll Contributing Editor For thousands of physicians on the West Coast, ringing in the New Year signified more than the annual renewal of hope. For many California physicians, Jan. 1 brought a new … Read more

The trend is unmistakable: Physician executives are leaving their high-pressure, high-paying jobs at health plans, and are starting from scratch in the nascent e-health industry. The lure? A chance to leave their mark on something. Bob Carlson Contributing Editor A number of senior physician executives are leaving managed care for e-health start-ups. Why would these … Read more

With Medicare for all emerging as a defining issue in the 2020 election, single payer health care seems more plausible than ever. But for Medicare for all to truly work for all Americans it must do more than provide uniform, basic insurance. It must also create room for consumer-driven choice. In more than 60 consumer … Read more

John Carroll After years of skirmishing over mental health parity, the battle lines are drawn. Troops are armed with a cache of talking points and data — pro and con. And, after a brief summer truce, another big showdown looms on Capitol Hill. This is a drama with more players than Richard III. Parity supporters … Read more

How much will plans have to “be like Mike” — Leavitt, that is. The influence of the secretary of health and human services reaches beyond the public sector. As Tommy Thompson exits the political arena, stage right, all eyes are shifting to the new leading man to direct health care policy in the United States: … Read more

Lax regulations and fee-for-service payment make an irresistible mix for physician conflicts. Are ACOs the answer? Almost 50 years ago economist Kenneth Arrow warned about agent moral hazard — the temptation for physicians to exploit their knowledge edge over patients for economic gain. Today, physicians are bombarded with potential conflicts of interests between their obligations … Read more

The outcomes for those patients are poor technically in contrast to folks who develop p novo AML. The variety of cytogenetic abnormalities at t-AML is very similar to p novo AML, however the frequency of adverse cytogenetics, like some intricate karyotype or deletion or loss of chromosomes 7 or 5, is significantly greater in t-AML. … Read more

All-products provisions in health plan provider contracts are slowly being negotiated, legislated, and regulated out of existence. They are now illegal in at least four states; legislation is pending in several others. Non-negotiable all-products requirements leave physicians with an all-or-nothing choice: Either agree to be on the provider panels for all current and future products … Read more

By Frank Diamond Senior Editor   When Rick Millard, Ph.D., made a presentation at the Data Integration and Analysis for Disease Management conference in March, he probably didn’t dream that the reaction would be so intense. Millard, vice president of clinical affairs for Patient Infosystems in Rochester, N.Y., reported preliminary findings on his company’s CareSense … Read more

Thanks largely to the spread of managed care, medical schools are minting increasing numbers of physicians who eschew specialty practice for primary care. Now, according to the AMA, primary care physicians are beginning to gain financial rewards for their choice, although their pay still lags behind that of specialists. Mean net income for general and … Read more

Tomorrows Medicine New drugs and devices that are shaping health care’s future. TOMORROW’S MEDICINE Multidrug Resistant HIV Drug Lauded, But Clinical Foundation Not Very Deep THOMAS MORROW, MD It is safe to say that few people read a June 5, 1981, report in the CDC’s Morbidity and Mortality Weekly Report that described five cases of a … Read more

Diseases will soon be defined by biochemical pathways and genetic interactions. Biochips may identify patients likely to respond to therapeutic agents. Thomas Morrow, MD TOMORROW’S MEDICINE Fans of the original Star Trek series will remember some marvelous technology displayed in and out of the Enterprise sick bay. The ship’s doctor, “Bones,” would hold a device … Read more

Health plans are expanding MTM — once considered a Part D mainstay — to their commercial businesses. Thomas Reinke MANAGED CARE October 2011. ©MediMedia USA Health plans are expanding MTM — once considered a Part D mainstay — to their commercial businesses. Thomas Reinke Results from an ongoing North Carolina medication therapy management program show just how … Read more

Final text of TPP has no biosimilar surprises The final full text of the Trans-Pacific Partnership (TPP) is out, and it will stir up some debate again over the massive trade deal. But for those watching how the trade pact might affect the international market for biosimilars, the unveiling of the full text doesn’t seem … Read more

Speaking of profitability problems, HMOs can at least be happy they’re not physician practice management companies. The PPM industry is trying to find its sea legs after MedPartners announced it would dump its 238 physician practices and concentrate on its pharmacy benefit management and other lines of business. The MedPartners decision effectively ices talk of … Read more

Name Last modified Size Description Parent Directory 26-Jul-2000 21:05 – 9808.washington_thom..> 29-May-2000 11:54 2k 9808.washington_tele..> 29-May-2000 11:54 1k 9808.washington_take..> 29-May-2000 11:54 2k 9808.washington_some..> 29-May-2000 11:54 1k 9808.washington_medp..> 29-May-2000 11:54 2k 9808.washington_gord..> 29-May-2000 11:54 1k 9808.washington_desp..> 29-May-2000 11:54 3k 9808.truce_gatechart..> 06-Jul-1999 09:06 16k 9808.truce.shtml 29-May-2000 11:53 24k 9808.states_texas.shtml 29-May-2000 11:53 2k 9808.states_statesde..> 29-May-2000 11:53 3k 9808.states_kentucky..> … Read more

California offers a prescription drug discount program that allows Medicare beneficiaries to get discounts just by showing their Medicare cards to pharmacists. Unfortunately, according to a new survey by the Kaiser Family Foundation, a majority of those eligible — both those with and without drug coverage — have never heard of the program. The findings … Read more

With limited peer-reviewed literature, health plans take an evaluative approach to tumor profile testing Tests that search for individual genetic biomarkers to guide drug therapy in cancer are giving way to a game-changing technology. Instead of looking for one specific genetic alteration, tumor profiling tests are using both first and next generation sequencing systems to … Read more

Younger Women Too Often Ignore Signs of Heart Attack Frank Diamond Managing Editor Blame Hollywood. Or, at least, partly blame Hollywood. (We’ll take what we can get.) Women ages 30 to 55 too often ignore the warning signs of an acute myocardial infarction (AMI), according to a study in Circulation: Cardiovascular Quality and Outcomes. They either don’t … Read more

Also available as PDF Most physician and lay managers in group practices saw modest compensation increases from 1997 to 1998. Medical directors, however, proved the exception, as their median compensation level fell 14 percent. A breakout of the data indicates that the more time spent on administrative duties, and the greater the share of practice … Read more

The former senior VP for health policy at UnitedHealth Group joins a company that aims to shift power from HMOs to patients and physicians. Lee N. Newcomer, M.D., could well have ended up as a lawyer or a biologist. A draft number of 25 in the early 1970s prompted him to apply to various graduate … Read more

Managed Care at the Crossroads As rising costs drive CEOs’ collective blood pressure off the charts, a group of experts considers whether managed care has reached another watershed — and whether the industry can reinvent itself yet again. Margaret O’Kane Gives the OK To Focus More on Providers The head of the National Committee for … Read more

Payers should benefit as the rate of introduction of blockbuster products declines When the Provenge prostate cancer vaccine was approved earlier this year, the closely watched move was greeted with an outpouring of hope and enthusiasm. This marked the first time that immunotherapy was endorsed as a weapon in the fight against cancer. Patients rejoiced. … Read more

Thinking about joining other providers in your area in an integrated health care delivery system? To ensure that your IDS isn’t just a “field of dreams,” be sure to take into account how you will market it. …and other critical marketing questions for integrated health care systems Like many physicians, you may be considering joining … Read more

Color chart Risk-sharing arrangements account for 31 and 48 percent of all HMO commercial and Medicare revenue, respectively. Hospitalization is the service most often placed at risk. Paul LendnerPaul Lendner ist ein praktizierender Experte im Bereich Gesundheit, Medizin und Fitness. Er schreibt bereits seit über 5 Jahren für das Managed Care Mag. Mit seinen Artikeln, … Read more

The French wellbeing unites worldwide policy with a people –private mixture of hospital and healthcare and a bigger amount of service supply compared to at the USA. Even though system is not even close to perfect, its own indications of health status and user satisfaction are high; its own costs, as a share of gross … Read more

As of March, about 7 percent of the 560,400 office-based physicians in the United States were actively writing electronic prescriptions, and about 73 percent of the 57,500 retail pharmacies were actively receiving them. By the end of 2008, the number of e-prescription transactions will reach 100 million, according to the Pharmacy Health Information Exchange, which … Read more

DIGITAL EDITION SUBSCRIBEBROWSE PAST ISSUES ISSUE APRIL 2018 Opioid Deaths Among Women Not Getting the Attention They Warrant FRANK DIAMOND Deaths of women from opioid addiction spiked 400%, according to CDC data. Alison Colbert of Duquesne University argues for a gender-specific approach. Social Determinants of Health: Stretching Health Care’s Job Description LOLA BUTCHER Providers and payers are being … Read more

A Minnesota medical group that contracted with HealthPartners, a not-for-profit HMO, was able to improve cost of care, physician compensation, and patient access without harming patient satisfaction when the group converted from a salary payment system for physicians to one solely dependent on physician productivity. Before 1998, physicians were paid a salary, with all their … Read more

Buy Health Insurance Like Car Insurance? The idea is to let employees to buy their own health insurance with the help of “defined contributions” from employers. Could the system handle such a change? Do we want it to? A Conversation With Peter I. Juhn, M.D. The executive director of Kaiser Permanente’s Care Management Institute talks … Read more

Aetna U.S. Healthcare has offered a bare-bones product it says is a step toward reducing the number of uninsured Americans. But a consumer group says Aetna’s Affordable HealthChoices plans would leave patients with huge bills if they needed serious care. The three products pay $50 for a physician visit and $500 or more a day … Read more

Call me. Participants in a Healthways diabetes management program who received four telephone calls encouraging healthy behaviors had greater improvements in HbA1c and LDL levels than those who received no phone calls…. A new study says employers need to bone up on benefit designs. Innovations in benefit design can make cost sharing an effective tool to … Read more

Aetna is unveiling something it calls the Medicare Open Plan, targeted for employers who want to offer retirees age 65 or over a fee-for-service Medicare Advantage plan. If CMS approves, Aetna hopes to launch the plan in January 2007…. A consumer-directed effort by Tufts Health Plan hasn’t planned out the way management had hoped. Tufts … Read more

“A person’s back there,” he said on the most recent bout of re-code Decode, hosted by Kara Swisher. “You can call some one and speak to them , however Twitter’s a pretty public moderate of course if you ask a brand about some thing then they are most likely to get straight back because they … Read more

Better comprehension of viral sciences and the roots of both influenza epidemics and pandemics can improve identification and disease control. Advances to halt the spread of disorder, including live-attenuated and inactivated vaccines and brand new antifungal agents, promise to reduce illness burden, mortality, and morbidity. One of a total of 72314 case records, 44672 were … Read more

Vaccines for chickenpox and herpes, the two variations of the varicella-zoster virus, are now available for children and the elderly, respectively Recently the U.S. Centers for Disease Control & Prevention’s 15-member Advisory Committee on Immunization Practices (ACIP) voted unanimously to recommend vaccination of those 60 and older with a new vaccine — zoster vaccine live, … Read more

It’s hard to get a handle on whether the HMO industry is headed for brighter days — or still in the doldrums. Weiss Ratings reports that 47 percent of HMOs lost money in the third quarter of last year. Aggregate HMO profits were $69 million, down from $274 million during the first quarter; losses started … Read more

As a baby boomer moving through middle age into the unspeakable age that follows “middle,” I was encouraged to read an article in the British Medical Journal that states that for seniors and super seniors, healthy behaviors that include regular exercise, not smoking, maintaining a normal Body Mass Index, and having a rich or moderate social … Read more

Every Year, the Country’s health system Spends countless dollars seeking to treathandle preventing a range of unfortunate ailments that just continue growing in prevalence. Chronic ailments. Patients who have chronic conditions account for 81 percent of hospital admissions, 91 percent of prescriptions filled and 76 percent of doctor visits. Roughly 86 percent of the $2.9 … Read more

Since the Beginning of the Medicaid Managedcare Disagreement in Iowa,” Gov. Terry Branstad over repeatedly has pointed out to the reality that 39 states and the District of Columbia have transferred portions of the Medicaid populations in to managedcare plans. That is surely correct. More than 70% of those Country’s 7 3 million Medicaid beneficiaries … Read more

The ability of the computer to find unexpected — and often unwelcome — patterns of utilization is at the heart of today’s fraud detection methods John Carroll Contributing Editor The people who signed up for the yoga classes offered in the basement of one Philadelphia building didn’t know that the program included regular bills for … Read more

President Trump is expected to issue an executive order today that will make sweeping changes to the country’s system of health insurance coverage and begin the unwinding of the ACA. The action is a result of the inability of GOP members of Congress to begin dismantling Obamacare. Trump has been vocal about his displeasure at … Read more

With All the youngest of these baby boomers hitting 65 By 2029, the range of individuals who have visual impairment or blindness from the USA is predicted to double to over 8 billion by 2050, based on projections on the basis of the latest census statistics and by studies financed by the National Eye Institute, … Read more

Name Last modified Size Description Parent Directory 26-Jul-2000 21:05 – 9808.washington_thom..> 29-May-2000 11:54 2k 9808.washington_tele..> 29-May-2000 11:54 1k 9808.washington_take..> 29-May-2000 11:54 2k 9808.washington_some..> 29-May-2000 11:54 1k 9808.washington_medp..> 29-May-2000 11:54 2k 9808.washington_gord..> 29-May-2000 11:54 1k 9808.washington_desp..> 29-May-2000 11:54 3k 9808.truce_gatechart..> 06-Jul-1999 09:06 16k 9808.truce.shtml 29-May-2000 11:53 24k 9808.states_texas.shtml 29-May-2000 11:53 2k 9808.states_statesde..> 29-May-2000 11:53 3k 9808.states_kentucky..> … Read more

For physicians, reclaiming a measure of clinical autonomy can be a matter of health itself. But alas, there’s no one blueprint to follow. Burnout can be subtle,” says John Henry Pfifferling, Ph.D. “It is a slow, aggregating erosion of energy. It’s not something that happens overnight. You no longer look forward to working. You no … Read more

America criminal justice process would be the largest on the planet. Under some sort of pest control from the USA, for example 2.2 million incarcerated in national, state, or regional prisons and jails. Even the U.S. is really a global pioneer in its rate of incarceration, dwarfing the speed of every other state. U.S. criminal … Read more

Information technology companies are salivating at the prospect of tens of billions of dollars’ worth of business, now that the Health Insurance Portability and Accountability Act (HIPAA) privacy rules have taken effect. And for all the whining about HIPAA from providers and payers, there are reports that a growing share of them are beginning to … Read more

Providers that once feared insurers’ retribution are finding strength in numbers and compensation in class action litigation Health insurers are under siege, and it’s not from stockholders upset over cratering equity prices. Lawsuits are coming at the plans from places they haven’t come before at a rate they have never seen before. “Volume has increased … Read more

Entire Worldwide spending oncology Drugs — for Example Curative treatments and supportive attention — reached the 100 billion threshold at 2014, whereas spending oncology medication at the U.S. climbed 5.3 per cent compounded annual growth pace in 2014 to reach 42.4 billion, based on another report. Total international spending oncology drugs — for example curative … Read more

To meet this goal, recommendations in prevention, identification, and treatment have to be implemented extensively into the US populace. That public is currently described by an amazingly shifting demographic profile. In the previous few years, the US populace has become more ethnically diverse as it was. The existing representation of non-Hispanic whites in this country … Read more

By drawing on the expertise of pharmacy benefit managers, managed care plans can teach plan sponsors and brokers the value of pharmacy, and in the process, add to their business. Todd Gibson Recent research shows that pharmacy benefit managers are a powerful but often untapped resource for educating insurance brokers, those who facilitate the deals … Read more

Color charts A California Medical Association study suggests that not-for-profit health plans in the state generally spend more money on medical expenses than their for-profit counterparts do. Not-for-profits broke even, on average, during fiscal 1996 – 97, while for-profits pocketed small gains. Among California health insurers and managed care companies with 50,000 or more enrollees, … Read more

A CONVERSATION WITH TOM MILLER Tom Miller, the director of health policy studies at the Cato Institute, says choice matters more than antiquated systems. Tom Miller is director of health policy studies at the Cato Institute, a conservative, nonpartisan public policy research foundation founded in 1977 and based in Washington, D.C. The institute is named … Read more

Weight or fat loss surgery is Meant to Offer weight reduction adequate to Decrease morbidity and Mortality hazard and improve clinical conditions when less invasive procedures of weight loss, namely Physician supervised weight reduction programs or obesity disease control programs, never have been Surgery combined with their various federal bariatric surgery certificate programs right to … Read more

This analysis was made to decide if genotype testing for patients beginning warfarin treatment will lower the prevalence of hospitalizations, for example those as a result of bleeding or thromboembolism. Wallpaper: Techniques: To appraise for temporal fluctuations in positive results of warfarin therapy, another diagnosis when results for two outside controller groups attracted from exactly … Read more

In California, Aetna U.S. Healthcare has addressed a major complaint of the state’s leading physician organization — that relatively low capitation rates force pediatricians to eat the cost of recommended vaccines. Aetna’s California plan will begin to pay physicians for any immunizations newly recommended by the American Academy of Pediatrics and the Centers for Disease … Read more

BY NEIL CAESAR, J.D. As health care reform continues to reshape the way medical services are delivered, physicians will find it important to choose carefully the alliances they join and the managed care arrangements in which they participate. Previous columns have discussed the likelihood that health reform will push physicians toward seeking the best alliances … Read more

Lawsuit Claims Sexual Dysfunction Drug Cialis Tied to Skin Cancer PDE5 inhibitors may increase risk of melanoma   Seven men who were treated with Cialis (tadalafil) tablets for erectile dysfunction have sued Indianapolis-based Eli Lilly and Co., claiming that they later developed skin cancer that was related to the medication, according to a report in … Read more

Self-referral is not the biggest contributor to the growth of in-office imaging by physicians, according to a report prepared by the Lewin Group for a coalition of physicians and medical groups. Rather, it’s the immediate access to imaging results and the expanded uses for diagnostic imaging that drive the growth of these technologies. The report … Read more

Clinics, medical insurance policies and other healthcare businesses nationally function. Our account cards really are a set of our Certification, recognition, certificate and distinction apps in 1 place. It’s really a”go to” source for those that desire to view how well their pro, clinic or plan maintain people healthyand treat disease and also meet patients. … Read more

John Marcille There’s a lot about technology in this issue. A story examines how health plans are dealing with the genomics revolution. Read about some amazing patient-monitoring systems that promise a bright future for disease management. Then get a glimpse at how information technology might at last foster greater cooperation between health plans and provider networks. I say … Read more

“pinpointing highrisk classes helps to prevent excessive screening which could be insecure and costly, and also to establish who must be screened and that are an applicant for pre emptive antibiotics or isolation ” CP-CRE, that stands to get carbapenemase-producing carbapenem-resistant Enterobacteriacecae frequently affects patients from hospitals, assisted living facilities and other health settings that … Read more

An anticancer program to increase screening and counseling fell short of some of its objectives, according to a study in the government journal Preventing Chronic Disease. The Healthy People (HP) program, launched by the Department of Health and Human Services in 1979, tracks 10-year objectives for improving health based on guidelines from the U.S. Preventive … Read more

Name Last modified Size Description Parent Directory 30-Sep-2000 10:40 – 9808.news_whatstheri..> 29-May-2000 11:52 1k 9808.news_newdrugs.s..> 29-May-2000 11:52 1k 9808.washington_gord..> 29-May-2000 11:54 1k 9808.washington_tele..> 29-May-2000 11:54 1k 9808.news_wheres.shtml 29-May-2000 11:52 1k 9808.news_headlines…> 29-May-2000 11:52 1k 9808.states_kentucky..> 29-May-2000 11:53 1k 9808.washington_some..> 29-May-2000 11:54 1k 9808.compmon.shtml 29-May-2000 11:52 2k 9808.washington_medp..> 29-May-2000 11:54 2k 9808.states_texas.shtml 29-May-2000 11:53 2k 9808.washington_take..> … Read more

Although adherence rates among HIV/AIDS patients are as low as 50%, anything less than 100% is unacceptable because adherence to antiretroviral therapy (ART) is the primary factor that determines virologic suppression, disease progression, and even death. Therefore, evidence-based interventions to improve adherence have become a focus of formulary decision makers. One such intervention, known as … Read more

Schisms between HMOs and physicians in two states: In North Carolina, Blue Cross and Blue Shield’s Personal Plan HMO severed relations with MedPartners primary care doctors Oct. 13. The Blues rejected MedPartners’ “demand” for a payment hike of up to 30 percent, while MedPartners blasted the insurer’s “decision to negotiate … through the media.” In … Read more

The static approach overseen by United States Pharmacopoeia shortchanges beneficiaries and benefit plans As patients and their physicians go about the annual process of evaluating Medicare prescription drug plans, and as Medicare plan sponsors begin to develop formularies for plan year 2012, (and the Centers for Medicare & Medicaid Services (CMS) gears up to approve … Read more

How Managed Care Affects the Malpractice Liability Problem Managed care has the potential not just to achieve savings, but to improve health care outcomes dramatically. But does it create extra malpractice complications along the way? The experts disagree. An Emergency Physician Complains: ‘Your Patients Are Costing Me Money!’ In getting paid by managed care plans, … Read more

What happens when a group-model plan folds? It’s sink or swim for salaried physicians who never had to worry about the business side.   UPHEAVAL IN ALBANY For the past 19 years, Gary Kronick, M.D., had few worries. His practice, set up just outside Albany, N.Y., offered everything he desired upon leaving Philadelphia’s Hahnemann University … Read more

Retrospective Cohort Study of Medication Adherence and Risk for 30-day Hospital Readmission in a Medicare Cost Plan Angela K. Hochhalter, PhD ; Rashmita Basu, PhD ; Karim Prasla, PharmD ; Chanhee Jo, PhD Fixed-Dose Triple-Combination Treatments In the Management of Hypertension C. Venkata S. Ram, MD How Does Management of Echocardiography Affect Use Across Risk Groups? Andrea DeVries, PhD ; Gosia Sylwestrzak, MA ; Abiy … Read more

We need to reduce unwarranted geographical variations in care Elliott Fisher’s e-mail box is full these days, the result of communications with congressional staffers working on health care reform. Fisher and his team at the Dartmouth Atlas Project are intent on making sure the bills going through Congress help create an environment in which integrated … Read more

Chart pages from MANAGED CARE Plastic surgeons ask: What recession?   How much return does that PhD provide?   Pharmacists test payment model based on outcomes   Payers: Expect to feel a double-team pinch   Productivity continues to outpace compensation   School debt can be significant in primary care   California still golden for pharmacists … Read more

It has been a long time since Doug Ross, Mark Greene, Carol Hathaway, and the demanding Peter Benton were saving lives every week on our television screens (Carter, too, although he was often fumbling at the beginning). For some of us, though, it’s difficult not to think about the images and associations from the ER television series … Read more

Payment below the PFS can be built a number of kinds of providers for technical services, frequently in preferences for that no institutional payment has been made. For some services supplied in a doctor’s office, Medicare makes payment for physicians and other practitioners at one rate depending on the entire assortment of resources required in … Read more

A Historical Perspective on Where We Are Submitted by David Kibbe on Tue, 2012-01-17 23:57 David KibbeHealth and Human Services (HHS) just released data on 2010 health expenditures, reporting that we, as a nation, have now reached the $2.6 trillion mark, consuming 17.9% of our GDP. Reaching that new mark required 3.9% annual growth vs. … Read more

The very first individual to be identified using Ebola Outside Africa throughout the newest outbreak has been shipped home with a length of antibiotics to get fourteen weeks later seeking health attention at a Dallas hospital the other day, a hospital official said. The Patient, considered to be man, has been admitted into an isolation … Read more

A potential useful volume on ethics in critical care falls short of expectations, often skimming the surface of important debates I have been invited to review a publication from the Society of Critical Care Medicine titled Critical Care Ethics: A Practice Guide from the ACCM Ethics Committee, edited by Dan R. Thompson, MD, MA, and Heidi … Read more

François de Brantes, whose payment reform organization merged with the Altarum institute(link is external) about a year ago, has been fired. His last day was Friday. An email from Altarum’s president and CEO, Lincoln Smith, that circulated at the institute, said he had “tremendous respect” for de Brantes but after a reorganization “we have reached an impasse … Read more

We Want your help to protect patients out of Fresh anti-patient The regulations enables insurance providers to pocket our co-pay assistance, maybe not rely towards our annual allowance. Combine patients from throughout the united states by do it. Guideline set up which makes it possible for carriers and pharmacy benefit managers to buy paid TWICE … Read more

The proportion of Americans reporting treatment for diabetes who took oral medications to treat their condition rose from 60 percent in 1997 to 77 percent in 2007 — a 28 percent increase. During that period, the proportion taking insulin to control their diabetes fell from 38 percent to 24 percent, according to the Agency for … Read more

A medical ethicist says it’s time to acknowledge that limited resources will cover limited services Voicing the idea of rationing health care services is a political deathtrap, or so ethicist Leonard Fleck, PhD, has been told. Fleck, a professor of philosophy and medical ethics at Michigan State University, served on a committee that recommended to … Read more

The biggest for-profit and not-for-profit MCOs have been through rough times recently. How have their corporate cultures changed? Companies have separate identities, as distinct as you or me. Like us, they have histories. Events change them and, often, they influence events — especially if they are the two dominant players in their industry. The Kaiser … Read more

Companies test new approaches to funding the pharmacy benefit with the goal of saving money overall. MargaretAnn Cross Some employers have been documenting new ways to control medical costs through pharmacy initiatives in recent months, encouraging other companies to follow suit — as well as to try their own ideas. Efforts to reduce or eliminate … Read more

Residents and fellows want to work in the suburbs or city, where they have professional and personal ties, according to a survey by Cejka Search. The company gave questionnaires to about 16,000 residents and fellows. Of the 750 respondents, 95 percent said that they would prefer to work in the suburbs. Eighty-four percent selected a … Read more

Physicians find men lack interest in seeking medical care if they can’t get coverage for erectile dysfunction. When it comes to seeing their doctor, many men will figure out a way not to. Men have fewer routine encounters with the medical system as young people. They worry they’ll find out something is wrong and they’re … Read more

Purchasers are increasingly requiring health plans to focus on the quality of health care delivered to consumers, according to the National Business Coalition, which says that more health plans are reducing barriers to essential treatments. For example, 27 percent of plans are waiving copayments for diabetes drugs and 33 percent have reduced copayments… Low Medicare … Read more

Managed Care’s full collection of Compensation Monitor articles on physician and health plan executive compensation Depending on the flavor of primary care a physician practices, cumulative pay increases over the last five years have either been very good, in comparison to other health care professionals — or very poor. Warren Surveys, which tracks salary trends of … Read more

Many states have laws governing the timeliness of claims payments to physicians, hospitals, and other providers, but few such statutes have any real effect because of lack of enforcement or clarity. A handful of states are toughening their so-called prompt-payment laws, but most of these changes are coming at the expense of insurers. California lawmakers … Read more

Disease prevention and health promotion are fast becoming key parts of employer-sponsored health care programs and purchasing strategies as more corporations realize the importance of preventive services such as screening for early detection of disease or risk factors. The evidence for their use is convincing: Effective screening programs have cut mortality from stroke and cervical … Read more

At the Eshelman School of Pharmacy, has deep consequences to the area of medication delivery using red blood cells to take medication and subsequently using light to discharge them at precise locations. The procedure, which modulates a decades-long scientific obstacle, could radically lower the quantity of a medication required to treat infection and so sideeffects. … Read more

Affordable Care Act helps keep spending growth at modest level, report says Total health care spending growth is expected to average 5.8% annually over 2015–2025, according to a report published in Health Affairs and authored by the Centers for Medicare and Medicaid Services’ (CMS) Office of the Actuary (OACT). Projected national health spending growth remains lower than … Read more

The trend lines and bar charts are marching up. Investors are investing, insurers are extending coverage, health care systems are getting on board. But there are some skunks at the telehealth garden party: research suggesting quality and utilization problems and lingering uncertainty about reimbursement. Telehealth is one of the buzziest areas of American health care, … Read more

Automatic interchange at the hospital can disrupt medication therapy and affect outcomes in a suboptimal way It happens all the time. A patient is admitted to the hospital on one list of medications, and is discharged on a different one. That may produce several possible outcomes, but the ideal one is that the patient is … Read more

Payers and buyers are searching to comprehend how VBID fits in to how services have been chosen and paid for, so optimizing the maintenance given to your cash spent. Use the exact same anticipation for your own healthcare spending, nevertheless, and you may place your self up for disappointment. “Rather than concentrating on cutting edge … Read more

Urgent care is a booming part of American health care, but the market may be saturated in several places. Chicago, New York City, Phoenix, and Scottsdale, Ariz., are among the cities where the urgent care market is overbuilt, says Clifford Braff, managing director of the Braff Group, a Chicago brokerage company that represents sellers of … Read more

These systems can improve quality, but in their present state of development, they can annoy physicians and are underutilized Tom Reinke Mrs. Jones, a 64 year old with diabetes, goes to her physician’s office for an upper respiratory infection. She has not been there for a few months. The doctor greets her and notes that … Read more

Commercial and public payers concerned by prolonged hospital stays will be considering this μ-opioid antagonist Thomas Morrow, MD Passing gas has been, except for teenagers and the more obtuse movies, a social faux pas. However, for patients who have recently had abdominal surgery, passing gas is actually a landmark event, a sign that their bowel … Read more

Research says PA can help make treatments safer and more cost-effective, but data sharing must improve Health plans walk a fine line when it comes to requiring prior authorizations (PAs). Such rules can promote safe and cost-effective use of medications, but they can also be an administrative burden for everyone involved — doctors, pharmacists, PBMs, … Read more

Since 1997, Harris Interactive has asked the public to rank various industries by whether it feels they’re doing a good job in serving customers. The latest results, from a telephone survey of 979 adults taken between April 8 and 15, includes some disheartening numbers for both managed care companies and pharmaceutical manufacturers, but especially pharmaceutical … Read more

COMPENSATION MONITOR What distinguishes the better-performing medical group practice from all the others? The Medical Group Management Association wanted to know, and now it does — at least, it has the numbers. You can’t quantify inspiration, dedication, skill, and attitude, but you can look at many of the outward characteristics of physicians and practices. MGMA … Read more

A judge in Fort Worth last month ordered Harris Methodist Health Plan to stop fining physicians who exceed pharmacy budgets. District Judge Bonnie Sudderth ruled that Harris Methodist Health Plan’s risk-sharing mechanism violates a state law that bars HMOs from paying physicians or other providers in ways that even indirectly create incentives to limit medically … Read more

Needed: A New ‘Bill of Rights’ For Mental Health Care Providers Behavioral health care organizations, argues this administrator, are being monitored to death. He suggests that a set of ground rules be applied to avoid duplication and ensure fairness to all parties Whatever Happened to Exclusive Contracting? A few years ago, experts predicted that HMOs … Read more

Cancer care is becoming increasingly personalized. In one cancer after another, science is yielding discoveries about genetic mutations that affect survival and treatment outcomes. These discoveries are both prognostic, indicating tumor aggressiveness, and predictive, forecasting treatment efficacy. These discoveries have led to better survival and smarter treatment in some once-hopeless diagnoses. A decade ago, 80 … Read more

Paris-based Sanofi and its vaccines global business unit Sanofi Pasteur have announced a cooperative research-and-development agreement with the Walter Reed Army Institute of Research (WRAIR) on the co-development of a Zika vaccine candidate. According to the terms of the agreement, WRAIR will transfer its Zika purified inactivated virus (ZPIV) vaccine technology to Sanofi Pasteur. The agreement also includes Sanofi … Read more

Could avian flu give rise to a pandemic that might rival the fearsome Spanish flu? Is the nation – let alone any individual MCO – ready? These days, the phrase “blue flu” usually is applied to walkouts by police officers, but it just as readily could be used to describe the frightful influenza pandemic of … Read more

Medical Management Group of McKesson HBOC This article also available in PDF Abstract Purpose: Describe patient satisfaction and patient-reported outcomes after voluntary use of a telephone-based nurse triage service. Methods: A random sample of symptomatic callers who contacted the triage service in 1999 was identified. A computer-assisted telephone survey was conducted, resulting in a response rate of … Read more

The appropriate application of criteria for the use of palivizumab can save health plans a significant amount of money. Also available in PDF Introduction On June 19, 1998, the Food and Drug Administration licensed palivizumab, the first monoclonal antibody introduced into clinical practice for the prevention of an infectious disease — respiratory syncytial virus (RSV) … Read more

Poor people and ethnic minorities may not benefit as much from pay for performance (P4P) as originally thought, according to a study issued by the Rand Corp. In fact, rewarding primary care physicians through P4P for providing better care may widen medical disparities that this population experiences. Using a model that simulated a typical P4P … Read more

Based on the current trend, with specialty drug costs growing annually by 20 percent, they will account for more than a quarter of all outpatient pharmacy expenditures by 2008. These findings were reported in CuraScript’s Specialty Pharmacy Management Guide and Trend Report, an annual guide highlighting the effects of specialty drug costs on employers’ health … Read more

Nine states passed mandates in 1998 for external review of coverage denials. Five states’ new laws allow enrollees to appeal denials of coverage for both medically necessary procedures and investigational treatments. Also last year, nine states enacted direct-access laws, giving members of “gatekeeper” plans the right seek treatment from — depending on the state — … Read more

Comparison of Amlodipine/Valsartan Fixed-Dose Combination Therapy and Conventional Therapy The use of a single-pill combination of amlodipine/valsartan resulted in higher acquisition costs but fewer clinic visits, laboratory tests, and electrocardiograms — and therefore lower gross costs — compared with the use of individual drug components Teaching Residents Established Guidelines And Standards of Care To Strengthen … Read more

High-quality care is only part of the secret to scoring well on HEDIS. Understanding how to ‘do’ HEDIS is equally important. The business of HEDIS help is thriving. It wasn’t long ago — just two or three years –that the National Committee for Quality Assurance’s Health Plan Employer Data and Information Set had yet to … Read more

The newly approved product produces 8 mg of naloxone to the rectal cavity. The FDA had approved 2 mg and 4 mg naloxone nasal-spray solutions. Naloxone is a medication Which Can Be handled by people with Or without clinical practice to decrease opioid symptoms. When naloxone is treated fast, it might counter the opioid overdose … Read more

Abstract Background: The high rate of 30-day hospital readmissions among Medicare patients highlights a glaring care gap in the treatment of elderly patients. To improve quality of care, increase patient safety, and reduce the associated costs of these readmissions, transitional care programs are being implemented to facilitate continuity of care from hospital to home with the … Read more

Frank Diamond Clinician executives at health insurance plans can stop worrying about whether consumers are savvy enough to navigate the changing landscape of coverage and start worrying about how small businesses will fare under the Affordable Care Act. (Well, keep worrying about both because both will continue to be problems.) Let’s just look at small … Read more

A survey by the Center for Studying Health System Change offers insight into how physicians’ views of managed care have changed as the payment system has evolved. A strong emphasis on primary care and tight limitations on specialty care were hallmarks of managed care in the mid-1990s. Now, the data seem to indicate, reduced reliance … Read more

Aetna Joins With Providers In Private-Label Health Plans Thomas Reinke A partnership with a respected hospital system or large physician practice could increase a health plan’s market share A Conversation With Peter Kongstvedt, MD: Provider & Manufacturer Pricing Need Reform Too As the ACA brings access to insurance, it could trigger consideration of price controls … Read more

More than a year after the passage of the Accountable Care Act (ACA), employers have seen an average increase in enrollment of their employees in health plans of around 2 percent, probably because the act extended eligibility for coverage of employees’ children up to age 26. That number is going to grow by another 2 … Read more

COVER STORY ‘Population-Based,’ Meet ‘Patient-Centered’ Two vaunted ideals of health care, experts say, should be perfectly aligned. And they almost are. Timothy Kelley How To Combat Pharma’s Costly Coupon Programs When drug manufacturer coupons make members’ costs for brand drugs equal to generics — or less — health plans, employers, PBMs, and members pay a … Read more

Recent court ruling means that beneficiaries should be notified about insurers’ decision-making powers Claims administrators have been put on notice by the Seventh U.S. Circuit Court of Appeals that employee benefit plans will need to spell out in precise detail their prerogative in making benefit decisions — or risk losing it. The court’s decision in … Read more

People who buy nongroup or individual insurance say their premiums have increased an average of 20 percent, according to a survey by the Kaiser Family Foundation. This increase has spurred 16 percent of them to search high and low for a better price for the coverage they want, but they’re coming up short. Buyers who … Read more

Last month, we advised physicians not to allow themselves to be decredentialed without putting up a fight. This month, we advise managed care organizations that, well, physicians are going to fight decredentialing — and as a result, MCOs should approach this process very carefully. There are many forces at work resulting in increased scrutiny of … Read more

Package designs Offering more-thorough self-administration Directions can help pharmaceutical businesses address patient adherence difficulties. 25-27; even Las Vegas Convention Center), Alan Davies, world wide design director, Essentra (Booth Number N-540), can talk how engaging, how smart packaging may permit better communication to patients that are controlling their doses in your home. Davies replies Afew Questions … Read more

Changing the process and mindset of health care professionals was the key to reducing emergency department overcrowding Joseph R. Twanmoh, MD, FACEP Assistant Professor of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Md. Gail P. Cunningham, MD, FACEP Head, Department of Emergency Medicine, St. Joseph Medical Center, Towson, Md. Full text in PDF … Read more

Two phase III, placebo-controlled studies evaluating dupilumab (Regeneron Pharmaceuticals/Sanofi) in adults with inadequately controlled moderate-to-severe atopic dermatitis (AD) have met their primary endpoints. In the studies, known as LIBERTY AD SOLO 1 and SOLO 2, treatment with dupilumab as monotherapy significantly improved measures of overall disease severity, skin clearing, itching, quality of life, and mental … Read more

Neither providers nor health plans have had an incentive to manage post-acute care. That’s changing. Metrics and predictive analytics can help. For health plan leaders tasked with finding ways to manage the cost and quality of care delivered to their members, it is frustrating when patients with nearly identical diagnoses and levels of function follow … Read more

The $60 billion to $108 billion that could be saved through tort reform would help 2.4 million to 4.3 million uninsured get coverage, the government claims. John Carroll Depending on which side of the political divide you sit, federal medical malpractice reform limiting noneconomic damages on medical cases to $250,000 would: Carve a whopping $60 … Read more

Medicare demonstration projects and reform legislation should lead to ‘no outcome, no income’ policies, this population health expert says John Marcille When David B. Nash, MD, MBA, calls health care reform legislation a full employment act for the faculty and graduates of Thomas Jefferson University’s two-year-old Jefferson School of Population Health, he means it. Physicians … Read more

HDAC inhibitor is administered with azacitidine   August 2, 2016 Tweet Widget(link is external) The FDA has granted breakthrough therapy status for the investigational drug pracinostat (MEI Pharma) in combination with azacitidine (Vidaza, Celgene) for the treatment of patients with newly diagnosed acute myeloid leukemia (AML) who are 75 years of age or older, or … Read more

Abstract Purpose: A minimally invasive endoscopic treatment that utilizes radiofrequency energy (RFE) has received increased attention as an appropriate middle-ground approach in the treatment of refractory gastroesophageal reflux disease (GERD) and as an alternative to complicated and invasive surgical procedures. The objective of this study was to develop a longitudinal budget impact analysis from the payer … Read more

SNAPSHOT With the rising costs of prescriptions and other issues relating to implementation of the new Medicare drug benefit, it is no wonder that policymakers are considering new approaches to addressing drug costs. And while prescription drug spending is a relatively small fraction of national health care spending, it is one of the fastest growing … Read more

Dyslipidemias, diseases of lipid metabolism, are all significant Risk factors for cardiovascular problems. Identification of kids with dyslipidemias can cause interventions targeted at diminishing their chance of CHD because adults. To Find out the advantages and limitations of signs about the Effectiveness of choosing, testing, and managing kids and teens with dyslipidemia at the length … Read more

LOOKING FORWARD For other articles in the series, see listing at end Richard Hamer The two main players in the managed care industry have their work cut out for them for the next several years. While HMOs retrench, physicians need to become more constructive participants. The biggest wild card facing the industry in the next … Read more

The National Committee for Quality Assurance has used HEDIS to encourage health plans to nudge physicians into screening diabetic patients annually for retinopathy. But the message hasn’t taken; only 41 percent of diabetics in any given health plan receive routine eye exams once a year, according to 1998 HEDIS data. Now, a study in the … Read more

There’s more than one way to skin a cat, but all are not equally good. Is it time for another look at managed competition? Martin Sipkoff Resourcefulness, fairness, and a feeling of déjà vu emanate from Professor Alain Enthoven’s managed competition model. His vision of large regional health plan exchanges that encourage competition among physicians … Read more

Many PAs and NPs have ascended into places of direction within their HM classes or medical systems, sometimes even trapping the doctors. The Hospitalist linked together with both six PA and NP leaders at hospital Medicine to go over their career paths in addition to the type and range of their tasks. They clarified leadership … Read more

United HealthCare and Humana, two of the nation’s largest for-profit managed care companies, have agreed to a $5.5 billion merger. The resulting company will operate as United HealthCare in 48 states and Puerto Rico. The move is one of the largest instances yet of the consolidation taking place in the managed care industry. When con- … Read more

Presenteeism — the condition of being on the job, but giving less than 100 percent — is fertile ground for health plans with a suitable product. About 100 physicians in South Charleston, W.Va., have been offered a stake in keeping 10,000 Dow Chemical employees as productive as they can be. By going the extra mile … Read more

The analysis included individuals with MS and optic disease, which can be Damage to the nerve which transmits information from the eye into the brain. Optic nerve damage can be a frequent effect of the illness. “This research is exciting because It’s the first to show “this is done with a medication which has been … Read more

Insurers say opening up clinics in drugstores will make health care more convenient, more timely—and potentially less costly. But will it also bring unwanted commercialization and fragmentation? As health insurers and drugstores join forces to create clinics within the stores’ spaces, they’re betting that their gamble to provide easily accessible medical care will pay off … Read more

Imagine an America where few businesses purchase health care for employees. Should that come about, the individual market will have new products ready. If employer-sponsored health benefits go the way of the Model T, the big managed care companies in the Detroit market intend to be ready. In June, Health Alliance Plan made its first … Read more

EMPLOYER UPDATE Employers are beginning to tap into the groundswell of employee interest in reducing premiums. MargaretAnn Cross HCA’s employee newsletter has been focusing a lot on health care issues over the last two years, says Bob Read, director of benefit planning and design. HCA, which owns about 180 hospitals and employs 185,000 people in … Read more

Physicians are more likely to buy in if they see better outcomes — and financial rewards that go with them. Perhaps nowhere in medicine does the friction between physician and HMO translate into lost revenue more noticeably than in disease management, where lack of doctor buy-in is a perennial complaint. The author, a former medical … Read more

Nowhere To Go But Out? Tracking Medicare+Choice Managed Medicare’s trouble may have something to do with underfunding or rich benefits, but for health plans, market share has a lot to do with it, too. Blueprint for the Future? Or Trapped in a Lockbox? The Federal Employees Health Benefits program has been touted as the way … Read more

Health plans hope to rein in utilization by raising pharmacy copayments. Whether the scheme works or backfires depends on how it’s implemented. Main story Sidebar: The intricate relationship between costs and compliance Chart: Pharmacy cost and utilization trends Chart: Comparing spending for direct-to-consumer advertising with pharmaceutical utilization trends Chart: Medication compliance rates for selected illnesses few items from the … Read more

In this study, outpatient management was effective in controlling nausea and vomiting during pregnancy and was associated with a reduced need for hospital or emergency room treatment as well as reduced costs. David G. Lombardi, MD University of Kentucky, Department of Obstetrics and Gynecology, Lexington, Ky. Niki B. Istwan, RN Matria Healthcare, Department of Clinical … Read more

Two vaunted ideals of health care, experts say, should be perfectly aligned. And they almost are. Health care doesn’t lack for big ideas, even if their definitional boundaries do sometimes get fuzzy. Take “population-based medicine” and “patient-centered health care,” for example. Both are phrases we hear and read every day, and maybe even believe in. … Read more

Who Will Fund Tomorrow’s Breakthroughs in Medical Research? The managed care industry has been blamed for slowing the flow of research funding. The true story is more complex. Needed: Strategies To Get Physicians To ‘Buy in’ to Disease Management Disease management programs can’t succeed without the full support of physicians. But how do you obtain that … Read more

Next year is a big year for Medicare Advantage plans. In 2015, they will not receive bonuses unless they have a 4-star rating or above. Many health plans are feeling under pressure right now, and may even feel a little disgruntled, as their businesses could really take a hit next year if they fall even … Read more

Full text in PDF ABSTRACT: The purpose of this study was to corroborate an earlier study that explored the relationship between a health plan’s Health Plan Employer Data and Information Set (HEDIS) score for glycolated hemoglobin (HbA1c) control in diabetes patients and its utilization of insulin and oral diabetes products. Prescription volumes were tracked for four … Read more

Master the ‘ABCs’ of Activity-Based Costing Pam Schuneman, C.P.A., M.B.A. How do you find out whether a given capitation rate will be profitable for your practice? Activity-based cost accounting is one tool that can help. An accountant explains how it works. The last 10 years have brought substantial changes to the health care industry. Managed … Read more

Individuals who turn 65 after 20-19 wont be allowed to select Medigap supplement Strategy F, typically the very common supplemental plan which helps retirees pay for health costs that Medicare will not cover. Retirees in Plan F year’s end is going to be permitted to keep. Nearly 60 percent of those 14 million people who’ve … Read more

Generic versions of Prozac (fluoxetine) have been available to patients for approximately 18 months, and a court decision is expected this month on whether generic Paxil (paroxetine hydrochloride) may be marketed. Yet in the face of this, several SSRI brands have increased HMO drug formulary access. We analyzed 2001 and 2003 data from MediMedia’s Formulary … Read more

Just because you hear a whistle from two miles down the track doesn’t mean it’s time to hoist your heavy suitcase. American health care has been waiting a while for “value-based payment” to pull into the station. But don’t look for it to fully arrive in 2016. Propelled by the ACA’s ACOs and new Medicare … Read more

United HealthCare is investing heavily in the Southeast’s managed care industry. The Minneapolis-based company intends to purchase HealthWise of America (not to be confused with Utah-based HealthWise, a Blue Cross and Blue Shield affiliate). HealthWise of America, based in Nashville, Tenn., operates HMOs with about 154,000 enrollees in Arkansas, Maryland, Kentucky and Tennessee, and plans … Read more

Think of P4O as P4P with its eyes on the prize. Unfortunately, even ordinary P4P is not yet widespread. Joseph Burns Contributing Editor For many years, managed care plans have used pay-for-performance programs to reward hospitals, physicians, and other providers for following guidelines and improving care processes, but few use P4P to improve clinical outcomes … Read more

Demystifying Pathways in Oncology High costs mean a sea change in cancer management is urgently needed, and these tools can chart the way without eroding the physician’s role William J. Sullivan, MBA High costs mean a sea change in cancer management is urgently needed, and these tools can chart the way without eroding the physician’s … Read more

Paying for coordinating care and for packages of services — bundling and episodes of care — may be the best bet for a modification of the unfettered fee-for-service system Tom Reinke In a March editorial in the New England Journal of Medicine, Karen Davis, PhD, president of the Commonwealth Fund, called for basic and timely … Read more

Steven Andes, PhD, CPA Research Assistant and Professor at the University of Illinois at Chicago, Director of Physician Information and Research, American Osteopathic Association, Chicago, Ill. Lawrence M. Metzger, PhD, CPA Professor of Accounting, Loyola University Chicago, Chicago, Ill. John Kralewski, PhD Wallace Professor of Health Research and Policy, School of Public Health, University of … Read more

It wasn’t long ago that Medicare held a special lure for HMOs, which saw the government’s foray into managed care as a lucrative opportunity. But if a PacifiCare decision last month is any indication, Medicare is no longer the golden egg. The company’s five-year strategic plan calls for aggressive expansion in the commercial market — … Read more

Because of this, FDA is working closely with the manufacturers to make sure a well-organized withdrawal out there from the USA, and also to make sure health care professionals have the information that they will need to closely sign their patients using Zinbryta to the following therapy. No new patients may begin accepting Zinbryta or … Read more

At what price will a member decide to forgo initiating a specialty pharmaceutical because the out-of-pocket (OOP) cost will cause financial hardship? Prime Therapeutics wanted to find out if there was an association between OOP expenses and abandonment of new prescriptions for tumor necrosis factor (TNF) blockers and multiple sclerosis (MS) specialty drugs. Patrick P. … Read more

With UM played out and copayments for brand-name drugs nearing most members’ pain thresholds, plans are exploring a new pharmacy frontier. After years of struggle as bit players, generic drugs finally have marquee power. Their supporters in the government and private sectors say generics perform so well they make older actors look tired and vastly … Read more

At a time in which top-selling meds are referred to as “blockbusters” and videotaped pharmaceutical messages fill physicians’ mailboxes, it is still sex, drugs and rock and roll that sell. Especially drugs. According to the New York Times, Americans spent more money on “anti-ulcerants” last year–$6.2 billion–than on any other type of medication. Antidepressants were … Read more

The medication is approved for use with a company diagnostic, the real-time IDH2 Assay, that will be utilized to detect certain mutations from the IDH2 gene in patients with AML. “Idhifa is a targeted treatment that satisfies an unmet requirement for patients With relapsed or refractory AML who’ve an IDH2 mutation,” said Richard Pazdur, M.D., … Read more

QUALITY MEASUREMENT It’s long been said that PPOs, by their varied nature, can’t be held to the same quality yardsticks as HMOs. Yet, in time, something will have to suffice. Michael Levin-Epstein Contributing Editor There are more Americans enrolled in PPOs than in HMOs and indemnity coverage combined. Yet while HMO performance largely has been … Read more

A pharmaceutical code of ethics — if it were ever hammered out — would have to arise from a detailed examination of the industry’s vision, mission and principles. It would likely cover methodology, safety, marketing and pricing. It would certainly cover communication with patients and the public. It would be aspirational instead of dutiful. It … Read more

Submitted by Steven Peskin MD on Fri, 2012-09-21 11:05 As a baby boomer moving through middle age into the unspeakable age that follows “middle,” I was encouraged to read an article in the British Medical Journal that states that for seniors and super seniors, healthy behaviors that include regular exercise, not smoking, maintaining a normal Body … Read more

When uninsured immigrants fail to pay their bills, the University Medical Center in Tucson, Ariz., might just report them to the Department of Homeland Security. The folks at University Medical Center in Tucson, Ariz., have come up with an interesting strategy to reduce financial losses from uncompensated care. Their idea is to report to the … Read more

The quality of care delivered by health plans that publicly report their performance improved from last year, but gaps in quality remain and contribute from 42,000 to 79,000 avoidable deaths every year, according to a newly released study by the NCQA. The performance improvement recorded last year by the 563 health plans was among the … Read more

The patient mandate, which needs many U.S. citizens and non citizens who officially live in the united states to own medical health insurance policy fulfilling defined standards and that imposes penalties on people lacking any exemption who usually do not honor with As section of repealing the mandatethat the policy examined could remove the punishment … Read more

PDF version:  1301.peer_mnt.pdf ABSTRACT Objective: To evaluate the incremental cost of and health benefits attributable to medical nutrition therapy (MNT) for managed care members participating in an obesity-related health management program. Design: Retrospective case-control. Methodology: Overweight or obese adult managed care members who utilized the MNT benefit (n=291) were matched, using propensity score matching, with … Read more

Embattled blood-testing company Theranos Inc. has informed health regulators at the Centers for Medicare and Medicaid Services (CMS) that it has dumped all of the results obtained with its Edison testing devices in 2014 and 2015, according to a report in the Wall Street Journal. The company also disclosed that it has issued tens of … Read more

Merck’s celebrity PD 1 inhibitor Keytruda has demonstrated promising results at the treating treatment of patients having metastatic triple unwanted breast cancer, which makes it a possible competitor to Roche’s TNBC treatment Tecentriq. Pivotal phase3 statistics, shown at the ASCO 20 20 meeting, revealed that Keytruda together with chemotherapy reduced the probability of passing by … Read more

When many randomized trials are badly done or irrelevant, what are formulary managers and committees to do? Sean Karbowicz, PharmD, has some sobering news for anyone who designs clinical trials: Most of them really aren’t very useful for the managed care organizations that make coverage decisions. Too often, he contends, the studies contain a flaw … Read more

Tomorrow’s Medicine B-cells and their markers, once overlooked in the pathophysiology of rheumatoid arthritis, may hold the key for a new treatment regimen Thomas Morrow, MD Recently an elderly woman looked with excitement at her first great-grandchild. As with all mothers, young and old, she is filled with the irresistible urge to cuddle the miracle … Read more

Everything is relative, but there’s been what many experts describe as substantial growth for a lot reasons John Carroll Contributing Editor Of all employers, noted Mercer, close to 1 in 4 now offers a CDHP to staffers, and the bigger the company, the more likely CDHPs figure in the mix. More than a third of … Read more

The Medstat Group is developing a database intended to generate an elusive outcome metric: effect of illness on employee productivity. Medstat will crunch medical and pharmacy claims, absenteeism, and disability and workers’ compensation data to develop an indicator of cost and quality of care…. Mental health parity legislation is picking up speed in Washington. The … Read more

In response to concern that there will be a shortage of physicians, the Association of American Medical Colleges (AAMC) recommends a 30 percent increase in U.S. medical school enrollment by 2015. A new report from the AAMC’s Center for Workforce Studies suggests that enrollment is on track to reach that goal, but by 2018, not … Read more

When New Drugs Are Costly, How High to Raise Copays? As some pretty costly, yet very useful, drugs are introduced, will new formulary designs deny access to needy patients? John Carroll Retail Medical Clinics Draw Patients & Payers A growing number of health plans are adding these clinics in retail stores to their networks and … Read more

5 Trouble Spots You Could Face In Implementing the ACA With the Affordable Care Act taking effect in just six months, unfinished regulations, obscure reform mandates, and unintended consequences create a potential minefield for payers Michael D. Dalzell A Conversation With Jonathan P. Weiner, DrPH: Information Technology Required A heath data pioneer launches a center … Read more

Washington Watch Do two recent advisory opinions from the Health and Human Services Office of the Inspector General signal some moderation in federal policy on what constitutes a kickback? Maybe. Or then again, maybe not. Consider the case of a not-for-profit hospital, which operates a cancer facility at its main campus plus a satellite center … Read more

The FDA has given the green light to Descovy (emtricitabine 200 mg/tenofovir alafenamide 25 mg [F/TAF], Gilead Sciences), a fixed-dose combination for the treatment of human immunodeficiency virus-1 (HIV-1) infection. Descovy is indicated for use in combination with other antiretroviral agents in adults and pediatric patients 12 years of age and older. Descovy is not … Read more

The popularity of loosely controlled benefit plans comes at the expense of HMO enrollment, which fell by more than 700,000 — about 1 percent — from July 1, 1999 to July 1, 2000. InterStudy Publications says HMO enrollment peaked at 80.8 million in July 1999. The heaviest losses came in the Southeast, where 928,000 people … Read more

With two new treatments available, earlier diagnosis of alpha1-antitrypsin deficiency won’t leave patients breathless for too long. Thomas Morrow, MD MANAGED CARE February 2004. ©MediMedia USA With two new treatments available, earlier diagnosis of alpha1-antitrypsin deficiency won’t leave patients breathless for too long. Thomas Morrow, MD Alpha1-antitrypsin (AAT) deficiency, a rare genetic disorder characterized by reduced serum … Read more

If clinicians could get a earlier warning, there often would be time to forestall a full-blown ‘brain attack’ A stroke is one of the most feared medical conditions a person can face. About 2,400 years ago, Hippocrates provided what is most likely the earliest description of what we now term a stroke: a sudden onset … Read more

Employers know that managing chronic conditions and preventing drug-drug interactions can boost productivity There’s no denying that the medication therapy management programs (MTMPs) mandated for Medicare Part D plans have been beneficial for seniors, producing positive results that help seniors live healthier lives. The basic principles of these programs are transferable to commercial populations, providing … Read more

The Huge majority of Americans are getting Positive encounters with the healthcare system, however, 21 per cent of adults report having experienced a medical mistake, based on a new nationwide survey published today by the IHI/NPSF Lucian Leape Institute and also NORC at the University of Chicago. The poll further discovers that, when errors don’t … Read more

Notwithstanding a black box warning from the FDA, ongoing research demonstrates the efficacy of treating adolescents and children with antidepressants Martin Sipkoff Perhaps no issue in mental health treatment is more emotionally laden and controversial than whether adolescents and children should be treated with antidepressants. “It has been an issue which has led to debate … Read more

At first glance, the ’98 HEDIS looks a lot like the ’97 model. But lift the hood and you’ll find that NCQA re-engineered HEDIS to give better performance, thanks to improved data-collection techniques. Michael D. Dalzell Senior Editor Sometimes, it’s what you don’t see that matters. Eight months from now, the 1998 Health Plan Employer … Read more

Sometimes patients are angry. Sometimes it is a symptom of their illness. Either way, nurses are on the front lines of health care and bear the brunt of the physical and verbal abuse from patients; gender may be a factor. In California, hospitals and other health care providers are now required to keep a log … Read more

Artiss, a fibrin product, is a breakthrough, allowing burn patients to avoid anesthesia, staples, and a subsequent operation to remove the staples Most people dread a severe burn. Each year there are about 2.4 million burn injuries in the United States; half a million people require medical attention, and approximately 4,500 die. Skin grafts are … Read more

Ezekiel J. Emanuel, MD, and Andy Slavitt will not let the ACA go gentle into that good night, and their arguments make for engaging reading in this print-free, all-Q&A edition of Managed Care (as usual, we’ve edited the transcripts for clarity and length). Print-free doesn’t mean no footprint, and Emanuel and Slavitt’s insights will be available in our digital … Read more

Nearly 60 percent of all surgical procedures take place in an ambulatory setting, where the patient receives less than 24 hours of hospital care, according to a recent report from the Agency for Healthcare Research and Quality (AHRQ). That’s good news to health plans, considering that the mean charge for ambulatory surgery is lower than … Read more

They are expected to survive and possibly even thrive no matter what form the health system takes under the Trump administration. When the dust finally settles on congressional Republicans’ seven-year quest to repeal and replace the ACA, who knows which parts of the law will survive and which won’t? But the ACO, a creature of … Read more

Offering 17P as a benefit to pregnant women enrollees with a history of preterm delivery can reduce NICU days significantly for a Medicaid plan. Mary V. Mason, MD, MBA Clinical Assistant Professor of Medicine, Washington University School of Medicine, Chief Medical Director Kara M. House, BS, MBA Manager of Quality, HealthCare USA of Missouri, St. … Read more

There’s a low-key war going on between community pharmacies and the big guys that offer drugs by mail. Is this about money or medicine? Jean Lawrence Linda is a 51-year-old woman on maintenance estrogen and medication for hypertension. When she mentions the cost, her primary care physician suggests she try her HMO’s mail-order option and … Read more

A National Judge in Delaware has announced that a jury decision requiring Gilead Sciences Inc to cover a record $2.54 million due to its own hepatitis C medication Sovaldi and Harvoni infringed a patent held by rival Merck & Co Inc.. The Verdict was the largest in a U.S. patent instance however U.S. District Judge … Read more

Leonard D. Schaeffer HEALTH PLAN 2009 Leonard D. Schaeffer is the chairman and CEO of WellPoint Health Networks. WellPoint and another Blues plan, Anthem, are in the process of merging. With 26 million members, the new entity, to be called WellPoint, would be the largest insurer in the nation. Health care is projected to grow … Read more

MANAGED CARE October 1998. ©1998 Stezzi Communications CARE MANAGEMENT: THE NEXT WAVE OF MANAGING CARE? The executive director of Kaiser’s Care Management Institute says guidelines have a place in every HMO, but there’s more to care than that. Medical roots run deep in the man who is leading the transformation of medical care delivery at the nation’s … Read more

Managed care contracts that pay you on a per-patient, per-month basis can be a good opportunity, but before signing you should evaluate the risk you’ll be taking on. Consider these five areas. Jeffrey J. Denning Contributing Editor Managed care contracts that pay you on a per-patient, per-month basis can be a good opportunity, but before … Read more

Speaking of Medicare+ Choice, HCFA issued an operational policy letter explaining how some reimbursement models will adapt to the new structure. The Balanced Budget Act eliminated prepayment plans, which provide only Part B benefits, and medicare risk contracts after this year, and cost contracts by 2002. Current cost contractors that also have a prepayment agreement … Read more

“Nasal polyps May Lead to lack of odor and Frequently patients need Operation to remove the polyps,” explained Sally Seymour, M.D.,” Director of the Department of Pulmonary, Allergy and Rheumatology Products at the FDA’s Center for Drug Research and Evaluation. “Dupixent has a significant treatment alternative for patients whose sinus polyps aren’t satisfactorily controlled by … Read more

Doctors working for a salary got a slightly better average pay increase last year (4.4 percent) than salaried employees in U.S. industry as a whole (4.2 percent), according to recently released survey results. Perhaps because of the “gatekeeper” duties many of them perform in managed care, primary care physicians were more highly paid by HMOs … Read more

The pharmacy profession continues to pay well, though where somebody practices has much to do with just how well, according to the 2004 Pharmacy Compensation Survey — Spring Edition by Mercer Human Resource Consulting. Pharmacists saw an average increase from 2003 to 2004 of 5 percent. Nationally, staff pharmacists were paid a median total cash … Read more

The first report issued by the Health Care Cost Institute made headlines last month not only for what it says but for how it came to say it. “Health Care Cost and Utilization Report: 2010” crunches 3 billion claims for more than 33 million members of three of the biggest health plans: Aetna, Humana, and … Read more

Origin of Mandates Wasn’t Spontaneous Generation Per-Patient Visits to Behavioral Therapists Drop 63% in Just Two Years, Study Shows The Waiting Game: Managed Care & Dentistry Combined managed health and dental coverage could save expenses for employers and improve care. But neither employers nor traditional managed care plans have shown much interest in packaged plans. … Read more

Prescription Drug Reimportation: Panacea or Problem? Health plans concerned about the cost of pharmacy benefits might want to look at potential effects of prescription drug reimportation — formulary issues and legal questions, to name two — even if full implementation is a while off. ‘The Best Is Yet To Come’ Managed Care for Affluent Elderly? … Read more

Health Reform and the Use of Financial Incentives in Wellness Programs Affordable Care Act Financial incentives Health Reform Outcomes based incentives Progress based incentives Wellness The Affordable Care Act codified the worksite wellness exemption to the federal medical underwriting provisions in the group health plan market. This means companies are allowed to use an “outcomes-based” … Read more

Invoked his Fifth Amendment right against selfincrimination and dropped to answer questions from US politicians enthusiastic about why he increased the purchase price tag on a life saving medicine by 5,000 %. Shkreli, 3 2, sparked outrage annually Among patients, medical analysts and Democratic Party front runner hillary-clinton later Turing increased the purchase price tag … Read more

Charges by lawmakers that insurers don’t spend enough on medical services lead to provisions in health reform bills in the Senate and House John Carroll MANAGED CARE January 2010. ©MediMedia USA Charges by lawmakers that insurers don’t spend enough on medical services lead to provisions in health reform bills in the Senate and House John Carroll As … Read more

Joyce Ochs Despite the technological advances of the past decade, a Star Trek world is still in the future for most of us. On the other hand, physicians today are writing prescriptions for patients on palm-held devices that seem eerily akin to medical practice on the Starship Enterprise. Hand-held computing devices are hot technology in … Read more

The major mobile communications companies are among the players that hope to cash in as technology meets growing needs Medical device manufacturers in the United States — the largest medical device market in the world — expect to see a 7% or more increase in sales in the coming years. In 2013, the medical device … Read more

Lance Poulsen’s lawyer would like everyone to know that his client has done nothing improper or illegal. Meanwhile, the company Poulsen founded and led until recently — National Century Financial Enterprises — operates under bankruptcy court protection. Seems that Poulsen scoped out a niche industry in the 1990s. He heard the cries of hospitals and … Read more

Managed care is forcing physician groups to guard their alliances zealously, and one way to do this is with noncompete clauses in physician contracts. Such clauses can help medical groups protect themselves generally against the threat of a physician employee departing with a host of patients that he or she acquired only through the group’s … Read more

The recent profusion of health care public opinion surveys hasn’t quieted debate over the public’s level of essential satisfaction with managed care. Different headlines trumpet different conclusions. As a health care survey professional, I’d like to suggest some ways to make sense of opinion surveys that appear to conflict, and to argue that they in … Read more

Click here for more information   Next chart Paul LendnerPaul Lendner ist ein praktizierender Experte im Bereich Gesundheit, Medizin und Fitness. Er schreibt bereits seit über 5 Jahren für das Managed Care Mag. Mit seinen Artikeln, die einen einzigartigen Expertenstatus nachweisen, liefert er unseren Lesern nicht nur Mehrwert, sondern auch Hilfestellung bei ihren Problemen. www.managedcaremag.com

After years of stagnation, organ donations are up, and organizations that collect organs for transplantation and the hospitals they work with say their partnerships have been the key to getting the numbers to grow, according to an article posted on the HealthLeaders Media website. The number of organs from deceased donors rose 5.6% in 2015 … Read more

Although they’re not quite an endangered species, primary care physicians aren’t exactly in high demand these days, either. That’s been the experience of a national physician search and recruitment firm, Merritt, Hawkins, & Associates, during the past five years. The plight of family practitioners, general internists, and pediatricians is reflected by the average salaries offered … Read more

Massachusetts can no longer require Medicare HMOs to provide unlimited prescription drug benefits. District Court Judge Richard Stearns decided that the federal law creating the Medicare+Choice program supersedes a state law barring prescription-benefit limits. The ruling pleased HMOs, which had been fighting for the right to reduce drug benefits, a move they said was needed … Read more

Our neighbors to the north deliver care that is cheaper, but there are disputes concerning quality and growing unrest with irrational rationing. Marlene Piturro, PhD, MBA Resources are finite. Demand is infinite. The United States and Canada have built health care systems that attempt to reconcile the irreconcilable imbalance between supply and demand differently. Adjacent … Read more

The Medicare+Choice program is in bad shape. Just look at its vitals: Forty-three HMOs in 30 states — including such heavy hitters as Foundation Health Plans, Oxford Health Plans and WellCare Management Group — as well as 22 “demonstration plans” have decided to pull out of the Medicare market before Medicare+Choice debuts next month, and … Read more

Boston Scientific’s Synergy stent is designed so the drug-eluting polymer breaks down. Are totally bioresorbable stents far behind? The Synergy stent made by Boston Scientific. It’s the first stent in this country with a bioabsorbable coating. Unless you are nearing Medicare age, you will not remember the exhilaration created by the introduction of the percutaneous … Read more

If you thought a lot of time and money was spent on Y2K readiness, you ain’t seen nothin’ yet. Complying with the new rules for electronic transaction standards under the Health Insurance Portability and Accountability Act (HIPAA) is expected to exceed Y2K in terms of dollars and work hours. Some estimates peg the cost to … Read more

The National Committee for Quality Assurance, which has long wrestled with how to measure the quality of PPOs, has settled on a way to begin. Late this year, NCQA will track member satisfaction; next year, it will unveil a full accreditation program for PPOs, which are less centralized than HMOs. NCQA will examine core systems, … Read more

Finally, it seems that there is a way to manage patients with multiple chronic conditions properly. Understanding and technology converge. It’s as if that relative — the one who people thought would never be able to hold down a job and who long ago packed his belongings into a 1958 Edsel and sputtered off toward … Read more

Is it worthwhile for even a computer-shy physician to spend a little time investigating the Internet and other online services? You bet it is. Here are some of the ways these resources can work for you. Anne Bilodeau Contributing Editor To a technophobe, “cyberspace” may seem as foreign the surface of Mars, and almost as … Read more

With big companies steadily reducing coverage for retirees, plans need to devise products for this needy population. In early March, managers at the giant auto supplier Delphi knew they were knee-deep in fiscal hot water. Their chief financial officer had just resigned after an audit pointed to accounting errors, and the company needed to make … Read more

Enrollment growth in consumer-directed or high-deductible health plans stalled last year, according to a survey by the Employee Benefit Research Institute and the Commonwealth Fund. “Enrollment in CDHPs and HDHPs is virtually unchanged from 2005,” says the survey. “Only 1 percent of the privately insured population ages 21-64 are currently enrolled in CDHPs, representing 1.3 … Read more

Companies that negotiate for better prices on specialty drugs without the incentive of discounts and rebates. Health care critics often want to eliminate the middleman. “If only we could get rid of…” they say, before they snarl at a PBM or a health insurer with abysmal social-media profiles. Even Atul Gawande sees middlemen as a … Read more

The alternate payment version is just a non traditional financial arrangement which rewards medical care providers that deliver cheap, supreme quality maintenance. Today we’re confronting the risk that pharmaceutical makers and carriers will probably adopt APMs like a payment system in a few instances. As pharmaceutical manufacturers face rising public anxiety over value and prices, … Read more

Your decision implies that approximately 2,400 additional kids inside the U.S. are entitled to get the medication, bringing the entire quantity of the qualified to receive its procedure while in the U.S. to almost 11,000. The FDA accepted lumacaftor/ivacaftor Last year for those who have CF ages 12 and older individuals who have just two … Read more

Building on a similar effort in California, Catalyst for Payment Reform is proposing a standardized set of 50 ACO measures. Some of the country’s largest purchasers are taking it to their health plans. Purchasers want IHA-PBGH measures but “also have some context-setting questions, like what was the spend on my people in the ACO” compared … Read more

An FDA-funded study may be a precursor to U.S. registries for tracking real-world outcomes. In Congress, another try at a device tax repeal is afoot. Researchers from Kaiser Permanente, Weill Cornell Medical College, and worldwide registries are voicing the importance of tracking the safety and effectiveness of medical devices through the use of device registries. … Read more

Sildenafil citrate has been the first oral medication approved for treating erectile dysfunction, that is often found in men who have cardiovascular illness. ED is defined as the inability to accomplish and manage an erection adequate for satisfactory intercourse. The incidence of medium to entire ED was reported to function as 30% in men aged … Read more

Clinical executives at health plans want to see how providers react to draft recommendation against procedure Frank Diamond Managing Editor “Watchful waiting”—that’s the managed care industry’s first reaction to the recent determination by the U.S. Preventive Services Task Force that prostate-specific antigen-based (PSA) screening may do more harm than good. Before adjusting their policies, health … Read more

Once you are wanting to conserve money with limited funds , you devote a whole good deal of time searching for methods to help you help save yourself a dollar. By packaging brownbag lunches into canceling your cable, you are consistently emphasizing how you can invest less. But some times, venturing out of one’s path … Read more

Drug improved progression-free survival in trial versus Tarceva or Iressa The FDA has approved osimertinib (Tagrisso, AstraZeneca) for the first-line treatment of patients with metastatic non–small-cell lung cancer (NSCLC) whose tumors have epidermal growth factor receptor (EGFR) mutations (exon 19 deletions or exon 21 L858R mutations), as detected by an FDA-approved test. The approval is … Read more

Do You Always Make Sure Patients Get Test Results? Many physicians are falling short when it comes to reporting test results to patients, a recent study shows. Such lapses could hurt both doctors and health plans in the quest for good patient-satisfaction scores. Would you believe that one in three physicians has no set policy … Read more

MANAGED CARE February 2003. ©MediMedia USA The Republican Mandate Bush has one year to deliver change, as promised. Medicare, prescription drugs, malpractice insurance are all on the table. John Carroll Contributing Editor Within the Beltway, the word has gone out: This is President George W. Bush’s second 100 days. Fresh from being hailed for leading the way … Read more

Selecting the most appropriate medical insurance program may take a decent quantity of research. Knowing the association between yearly premium fees, deductibles and co pays has been near the peak of the list. Recently, knowing the type of medical care system an idea provides in addition has become crucial. A growing amount of carriers now … Read more

The consumer-directed model isn’t taking the country by storm, but its innovations are influencing other coverage designs When several start-up companies launched consumer-directed health plans more than a half-dozen years ago, terms like “incremental change” didn’t come up much. “The founders of consumer-directed health care always saw this as a transformational strategy that would improve … Read more

How physicians view biosimilars is one of the wildcards that will determine how popular the drugs become. Gastroenterologists are especially important group because anti-TNF biologics(link is external), infliximab (Remicade) and adalimumab (Humira) are commonly prescribed for inflammatory bowel disease. When the American Gastroenterologist Association surveyed 180 of its members, it found a willing but wary attitude … Read more

Credentialing is utilised to appraise physicians for various goals and is demanded of virtually all physicians. It’s employed by physicians if assessing doctors for medical staff places and hospital statements so when registering in medical health care policies because a participating provider. Regrettably, this method have not been compact and will be quite frustrating and … Read more

Employers Want More Cooperation From Plans: A Conversation with Larry S. Boress The head of the Midwest Business Group on Health says insurers must pick up where PPACA left off Self-insured employers that have been pushing for lower health care costs and improved quality for years were let down when health care reform lost sight … Read more

Changes in reimbursement patterns for obesity drugs will take several years. Lifestyle changes remain the first approach. According to a recent survey, health plan pharmacy and medical directors remain skeptical about the value of obesity drugs. But drug companies are undeterred: The prevalence of obesity, and its dangerous comorbidities, encourage a demand by doctors for … Read more

A few major corporations, sometimes with the assistance of a traditional health plan, have made significant efforts to improve employee lifestyles Every week, members of a missionary group of registered nurses and health educators fan out to 165 Hannaford Supermarkets, scattered across the country. And for a short, focused break, on company time, moving mountains … Read more

Jeffrey Wasserman, Ph.D. The Medstat Group, Santa Barbara, Calif Gifford Boyce-Smith, M.D. Blue Shield of California, San Francisco David S. P. Hopkins, Ph.D. Pacific Business Group on Health, San Francisco Vernon Schabert, Ph.D. The Medstat Group, Santa Barbara, Calif Mayer B. Davidson, M.D. King-Drew Medical Center, Los Angeles Ronald J. Ozminkowski, Ph.D. The Medstat Group, … Read more

For Most critics of U.S. Medical Care, the Canadian Network of Universal healthcare is definitely seen as a different, superior version for the U.S. to follow along with. Canada’s singlepayer system is mainly publicly financed, as the U.S. comes with a multi-payer, profoundly confidential system. While dissatisfaction with all the U.S. medical care process is … Read more

All these will be the initial direct-acting antiviral remedies approved for Kids and teens with HCV. Direct-acting antifungal medications lower the quantity of HCV from your system by preventing the virus from multiplying, and generally, they treat HCV. “These attributes can help alter the picture for HCV therapy by Shifting an unmet requirement in children … Read more

BY CHARLES DOWNEY Contracting with large corporate laboratories to save money may be a winning health plan tactic in the cost-efficiency battle, but could be a losing strategy for quality and, ultimately, membership retention. To use Hollywood’s metaphor du jour: The bugs are traveling too far. Using distant labs that do mass testing can have … Read more

Whether a person is likely to develop diabetes, cancer, schizophrenia, or stroke will be reasonably well predicted, and tests can also determine whether a patient will respond to a given therapy. That’s the good part. Don’t miss the sidebar to this article: Roll over, Beethoven — your genetic profile’s in At GHI in New York City, … Read more

Defining discretionary health care is no easy task, but it may be imperative for ‘consumer’ health plans seeking to get patients more involved Defining discretionary health care is no easy task, but it may be imperative for ‘consumer’ health plans seeking to get patients more involved If a woman is experiencing chronic back pain, her … Read more

The United States Preventive Services Task Force has recommended against several screenings, yet health plans are finding that it’s not so easy to just drop coverage Senior Contributing Editor Once upon a time, we believed that if you stay outside when it’s windy and cold, you’ll get sick; that women should rest during their periods; … Read more

The fda-approved nivolumab in conjunction with cabozantinib as alcoholism therapy of patients with advanced renal cell carcinoma, in accordance with a manufacturer-issued pr release. The endorsement has been based, in part, according to statistics presented in ESMO Virtual Congress 20 20 from the period 3 check-mate –9ER trial, that comprised 651 patients with either advanced … Read more

Disease Management Health Plans Are Ill-Prepared for Looming Diabetes Epidemic The problem is outpacing insurers’ resources and perhaps even their commitment. Can the chronic care model help? Martin Sipkoff Contributing Editor Diabetes is creating an escalating economic crisis for our health care system. Health plans use a handful of approaches, but “many insurers remain unaware … Read more

Price and physician reluctance to swap it into complicated regimens for heart failure could explain tepid sales. Novartis’s Entresto came to market in 2015 in a blaze of glory. A combination of valsartan, an angiotensin receptor blocker, and sacubitril, a neprilysin inhibitor, Entresto’s rise to stardom started when its pivotal phase 3 study, the PARADIGM–HF … Read more